Lower Bowel 



in Health and Disease 





LIBRARY OR CONGRESS. 

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Shelf .3.2/ Co 

UNITED STATES OF AMERICA. 













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"Prevention is better than Cure, 
and far Cheaper!' 



The Brotherhood of Man, and the Sisterhood of 
Women, suggests that if you are blessed with the 
WEALTH of HEALTH, and do not require help 
from books on health, that then you will find 
HAPPINESS, in providing for your less fortunate 
brother or sister, by confering a blessing on them 
in pointing the way to HEALTH which is both 
Wealth and HAPPINESS, by purchasing some 
of the books in my catalogue, and presenting them 
to your friends. 

Send for list of books. 



W. A. BARNES, 

West lojd Street, 



NEW YORK. 



"Prevention is better than Cure and far Cheaper." 

THE 

Lower Bowel 

IN 

HEALTH AND DISEASE 

TREATS OF 

AU, DISORDERS OF THE RECTUM. 



THIS BOOK HAS BEEN PREPARED FOR THE 
EDUCATION OF LAYMEN. 

/ 

J^^ ' T is folly to be unwise 

if *r If ignorance is not bliss. 

( 0F ~G 181889' 

PREPAREiyfc.ND PUBLISHED BY ^V^^'NGTOt*' 

W. A. BARNES, 

West .[03d Street, 

N£*V;Yt)RK. 




m 






' *t* 



Copyrighted 1889 
By W. A. BARNES. 



INDEX. 



Preface, --..«,. ^ 

Introduction, - - - - . - 6 

The Digestive Tract, - - - - 13 

The Rectum, - - - - - - 19 

Disorders of the Rectum, 22 

Constipation, - - - - - -31 

Hemorrhoids or Piles, 61 

Prolapsus, - - - - -71 

Polypus and Tumors, 74 

Ulceration Within the Rectum, - - 77 

Stricture, - - - - - 83 

Fistula, 86 

Fissure and Painful Irritable Ulcer of the Anus, - 91 

Itching at the Anus, 96 

Neuralgia, - - - - - - 108 

Catarrh of the Rectum, - - - no 

Cancer, - - - - - - -113 

Palliative Treatment, - - - 118 

Hygiene of the Lower Bowel, ... 123 

Influence of the Mind, 129 



PREFACE. 



A notion has somehow possessed a great many persons 
that almost any disorder of the lower bowel may easily be 
removed, or at least made bearable from time to time ; 
that so long as one is not brought to bed by acute suffer- 
ing, these disorders are like a cold in the head and can as 
easily be endured, by getting accustomed to them. 

Common ignorance of physical self, supplemented by 
the literature and vulgar boastings of the Quack profes- 
sional pile curer and the manufacturers of ready-made 
pile medicines, have gone far to sustain the idea that 
rectal disorders are only passing events, common to the 
ordinary life, and were probably meant not to be cured, 
but to be endured. 

No greater mistake in the economy of human life 
was ever made than this neglect of a grave and serious 
disorder. 

These disorders are undoubtedly the underlying cause 
oi many serious ill-conditions of the body, which seem 
strange to the sufferer, because of ignorance of the 
cause. 

The enormity and serious influence of disorders of the 
lower bowel is fully appreciated by the intelligent 
physician, and there is hardly a case of illness in their 
practice, either in the office or at the bedside, but that 



4 PREFACE. 

the first question asked is " What is the condition of your 
bowels ? ' ' 

With the hope of creating a more general intelligence 
and correcting many ignorant ideas relative to the sub- 
jects of which this book treats, this compilation has been 
made. In its preparation great indebtedness is due to 
the writings of the late Dr. W. H. Van Buren and 
Dr. Charles B. Kelsey of New York ; Dr. Allingham, 
Dr. Lionel S. Beal and Dr. Benj. W. Richardson of 
England and Dr. Joseph F. Edwards of Philadelphia; 
Dr. George H. Taylor, Dr. Felix Oswald and Dr. L. B. 
Sperry, and that admirable Journal, ''Medical Classics" 
of New York. 

This indebtedness is not acknowledged in every in- 
stance by the medium of inverted commas and attaching 
the names of the authors, for the reason that the exact 
text has not always been followed, and technical language 
has been changed into common place phrase. 

The doctrines of compensation, action and reaction, 
and dependency, enter very minutely into the economy 
of the human body. As early as 550 years before the 
Christian era the following piece of wisdom was written 
down from the lips of iEssop. 

*' The Members of the body found fault with the 
Belly, for spending an idle luxurious life, while they 
were wholly occupied in laboring for its support and 
ministering to its wants and pleasures ; so they en- 
tered into a conspiracy to cut off its supplies for the 
future. 

The Hands were no longer to carry food to the 
Mouth, nor the Mouth to receive the food, nor the 
Teeth to chew it. 



PREFACE. 5 

They had not long persisted in this course of starv- 
ing the Belly into subjection, ere they all began one 
by one, to fall and flag, and the whole body to pine 
away. Then the members were convinced that the 
Belly also, cumbersome and useless as it seemed, 
had an important function of its own; that they 
could no more do without it, than it could without 
them ; and that if they would have the constitution 
of the body in a healthy state, they must work to- 
gether, each in his proper sphere for the common 
good of all." 

The truth which this old fable teaches, may with equal 
force be applied to the Rectum or lower bowel as well. 

Throughout this little book there will be found lan- 
guage, phrase and ideas, which have a marked similarity 
and which may truly be said, to be repetitions. But we 
claim to offer these pages as an educational influence 
against the misfortunes of ignorance, and have therefore 
kept before us the fact, that true and successful education 
demands iteration, and reiteration to drive home to the 
mind the lasting impression. 



INTRODUCTION. 



Health is that condition which comprises 
" a sound state of the body, in which the parts 
perform their natural functions, and there is 
mental vigor, moral purit}^ a vigorous body, 
beauty of face and form, with graceful carriage." 

In this advanced state of civilization, it is strange 
how much ignorance exists among all classes, as 
to the human body and its functions. 

It is a fact that human beings know something 
of almost all that goes to make up the sum total 
of our daily lives, in association with the world. 

Most men and women know something of the 
laws which govern countries and communities ; 
they are acquainted with commerce ; they know 
how to build ; how to co-operate for common 
safety and defence ; in a word there is hardly an 
external condition of human life that is not known 
to the masses, but when we ask ourselves, what 
do we know of our human body and its functions f 
we become aware of our ignorance, and discover 



8 INTRODUCTION. 

that we are utterly dependent upon a select class, 
known as ' • Doctors of Medicine, ' ' and into their 
hands we surrender ourselves for life or death. 
There are notable exceptions, but they only prove 
the rule. 

By the strict law of nature a man should die as 
unconscious of his death as of his birth. ' * In 
health he should be unconscious of his every day 
functional life." We often hear people say, "I do 
not know that I have a stomach, liver, kidneys or 
bowels. Nature acts with such ease and harmony 
that I only know I live and move and have a 
being. " By the hand of Nature death were equally 
a painless portion." 

" When we shall have learned this lesson, this 
benign process of Nature, by a careful study and 
loyal regard for her laws, then will death cease to 
be a dread, it will come as a sleep, without pain, 
anger or sorrow. The Greeks, true lovers of 
Nature, and obedient followers of her laws, looked 
upon death in childhood or youth as so untimely 
that the body was carried to the pyre at the break 
of day, lest the sun should behold so sad a sight 
as the young dead." 

In the preservation of life, health and happiness, 
there is no one portion of the body that bears so 
important a part in the economy of our physical 



INTRODUCTION. 9 

nature as the digestive tract, ending with the 
rectum, or lower bowel as it is called. 

We cannot commence too early in life the edu- 
cation of the young person to regard the call of 
nature, to evacuate refuse matter from the body 
and thus purify it for the performance of its na- 
tural functions. 

We ought to ' ' understand that all habits of life 
which are beneficial to the general health are for 
the benefit of the rectum ; while those habits that 
endanger the general health may first show their 
evil effects on that organ.' ' " It is quite apt to be 
so if the rectum for any reason is the weakest 
organ. Most rectal diseases are curable if rightly 
managed ; but it is far better, easier and safer to 
prevent them by taking proper precautions/ ' 
' ' Prevention is better than cure and far cheaper. ' ' 
We must learn to deserve health by the practice 
of such virtue in living that our Mother Nature 
will smile upon us and by an influence of which 
we cannot divine the source, w r e shall be lifted up 
into that better world of daily experience known 
as perfect health.^ 

<l By observing the health laws of Nature, a 
sound constitution can be very easily preserved, 
but if a violation of those laws has brought on 
disease, all we can do by way of "curing" is to 



IO INTRODUCTION. 

remove the cause ; in other words to prevent the 
continued operation of the predisposing circum- 
stances." 

It does no real good to pursue investigation for 
the purpose of finding the cause of disease and 
when found to sit down over it and try to guess 
what will be the best mode of removal. The thing 
to do is to remove it by the most expeditious plan 
laid down in the book of experience, and thus 
remedy the slight put upon Nature and her laws, 
which are always for the right and for the best. 

The history of knowledge is the history of tri- 
umphant progress. 

" The spell of supernaturalism is broken. The 
broad minded, free thinking creature of all races 
and religions, has awakened to a recognition of 
the fact that this world is not governed by capri- 
cious ghosts, but by consistent uniform laws, and 
that the study of those laws is a path to all the 
knowledge and happiness our nature is capable of 
attaining. Great progress and the accomplishment 
of wonderful results marks the onward march of 
civilization. Wealth, power and station are the 
rewards which have been attained by men and 
women from all walks of life. There is one excep- 
tion "The science of health is still a barren 
tree." " Our wealthy minds dwell in poorly 



INTRODUCTION. T I 

tabernacles; the right method of promoting man's 
physical welfare seems to be one of the utterly 
lost arts. ' ' Oswald. 

At whose door lies the fault of this ignorance ? 
Go into the public libraries and ask, — How many 
of your readers inquire for books on health culture, 
and they will tell you about one per cent. Go into 
the public book-stores, and ask, if books on health 
and physical culture sell, and they will answer, 
' ' Yes we dispose of a few during the year, but it 
is slow work. ' ' L,ook about in our large cities, 
and you will find a few Gymnasiums and swim- 
ming baths, but as a rule they are part of the make 
up of a Social Club, where food is dispensed at the 
hands of a French cook, and alcoholic liquors are 
free to all. Ask the physicians, w T hy we are not 
better informed, as to our physical natures, and 
they will tell you, that it is because we wilfully, 
persistently and premeditatedly avoid the study 
of first principles of natural living and make our 
daily lives a hit-or-miss game, — well to day, sick 
tomorrow, and then the doctor. 

A physical and health culture education may be 
secured by any one of ordinary intelligence, and 
on through life, it should be a part of the habitual 
reading to have at hand one or more of the inter- 
esting and attractive ' ' Health Journals ' ' that are 



12 INTRODUCTION. 

now published in every city in this country, 
1 ' Seek and ye shall find — knock and it shall be 
opened unto you/' to experience a foretaste of 
heaven on earth, by the enjoyment of health. 




THE LOWER BOWEL 

IN 

HEALTH AND DISEASE. 



THE DIGESTIVE TRACT, 

Before proceeding to a consideration of the 
disorders peculiar to the rectum, of which we 
shall speak later, it may interest us to understand 
the nature and construction of the whole passage 
through the body, from the mouth where food is 
taken in, to its end the anus, where the refuse of 
food and a portion of the waste material of the 
body is thrown out. 

Food when taken into the mouth should be 
torn apart and ground to a pulp by the teeth, and 
moistened by the saliva, so that it may be more 
easily swallowed. The saliva contains chemical 
agents which aid in turning starchy foods into 
nutriment for bodily tissue. From the mouth the 
food passes into the stomach ; here it is mixed 
with the gastric juice, another chemical, which 



H 

acts upon the food as a solvent, and still further 
reduces solids into a semi-liquid pulpy mass ; this 
is further accomplished by a motion which is 
given to the stomach, by its muscular tissue, 
which causes the food to be stirred up and around, 
until it is small enough to pass out through an 
opening at the lower right hand end of the stomach 
called the pylorus or gate of the stomach into the 
bowels. 

As the food passes into the bowels, it is first 
received in the duodenum (a twelve inch long 
space) which is the beginning of the small bowels 
and in circumference, somewhat larger. In the 
duodenum, the food comes in contact with the 
bile and the pancreatic juice ; by these two che- 
mical agents the process called digestion is about 
completed, although further on and throughout 
the whole extent of the small bowels digestive 
influence is being exerted, and the nutrient value 
of the food is taken up and absorbed into the 
blood circulation by which it is carried to the liver, 
heart, and lungs where it is purified, and then serves 
to rebuild tissue, repair bone, muscle and nervous 
waste. In the separation of the food nutrients in 
the bowels, the waste portions of the food are 
pushed forward to the lower end of the small 
bowels, and, at the lower right hand side of the 



*5 

abdominal cavity they are passed through another 
gate (called the caecum or ilio-csecal valve) into 
the large bowel, called the ascending colon, which 
takes an upward direction on the right side of the 
abdominal cavity, then turning passes to the left 
side, below the stomach and liver, and then des- 
cends on the left side, terminating in the rectum. 

The purpose of the colon in the economy of the 
body seems to be to receive from the small bowels 
the waste particles of food, and a portion of the 
waste of the bodily tissue gather this into a mass 
and urge it forward into the rectum, whence it is 
ejected from the body. The removal of waste 
from the body is also accomplished by the action 
of the kidneys and the sweat glands acting on the 
pores of the skin, and the common act of washing 
with soap and water. 

In the passage through the body from the mouth 
to the anus, there exists a lining of soft mucous 
membrane, of delicate formation, at all points 
crowded with blood vessels and nerves. In the 
pouch-like rectum the location of the bloodvessels 
is peculiar and somewhat different from other por- 
tions of the surface of the digestive tract. The 
blood vessels terminate in separate ends almost 
like a sac ; the blood is forced into them by the 
portal circulatory system and, at times, it is dull in 



i6 

its reaction or recirculation. These pouch-ending 
blood Vessels, and this dull circulation are the seat 
of many of the disorders of the rectum. 

When the act of defecation is normal and no 
extraneous causes are produced to interfere with 
nature, the healthful condition of the rectum is 
assured and no attention is called to the parts, 
that requires either the service of the physician or 
the layman. Nature is at her best, and health is 
in possession. 

Disorders of the rectum are largely caused by 
others of the digestive tract. Indigestion is not 
so frequently a disorder of the stomach as it is of 
the intestines, and the disorder in either case is 
not by reason of some functional change in the 
stomach or intestines, but the cause must be 
looked for beyond the circumscribed space of the 
abdominal cavity. The character of the food, the 
liquids drunk, the habits of life, the occupations, 
either business or professional, the clothing, the 
hours of sleep, all have a bearing on the digestive 
. act, and make or mar it, for health. The German 
physician, Dr. L,ustig, thus speaks of "Chronic 
Abdominal Ailments." 

"The fact that a sedentary habit of living is 
the cause of abdominal ailments in strong, well- 



17 

built and otherwise healthy individuals, is well 
born out by experience." 

As to the cause of this, there are many differ- 
ences of opinion among physicians. 

" We know as a positive fact that the proper 
normal oxidation of the blood is a much more im- 
portant factor in the preservation of health and 
life than the most bountiful table." 

' ■ Compare the physical daily laborers working 
in the open air, with those who work in closed 
rooms. The former present a robust appearance, 
and are less subject to disease than the in-door 
workers, and yet the latter are better served with 
food than the former, they earn more compensa- 
tion, and therefore can afford better living." 

1 ' With those who only exercise occasionally to 
the point of perspiration, there is imperfect oxida- 
tion of the blood." 

" It therefore follows, that when the blood is 
imperfectly oxidized, it must become vitiated and 
undergo change." This change as a rule consists 
of more or less thickening and is apt to stagnate 
in the portal system." (The blood vessels of the 
rectum are a part of the portal system) . When the 
blood becomes thus thickened, the glandular 
organs become engorged with blood, especially 
the liver, which as we know stands in the most 



18 

intimate relation with the portal system, conduct- 
ing the blood from the entire digestive tract to it.-" 

"When once the veins and venous plexus of the 
abdomen become engorged, this condition spreads 
to the large venous trunks, and as they possess an 
appreciable elasticity they become overfilled with 
blood, become tortuous in their course, causing 
larger or smaller nodules to form, which, when 
they make their appearance in the rectum are 
called hemorrhoids ox piles. 

1 ' The unnatural pressure which this plethora of 
the portal system causes on the sympathetic 
nervous system, produces many sad results of 
illness. When the overcharged venous system of 
the rectum presses upon its system of nerves, and 
this is further complicated, by constipation and 
pressure of fecal matter, then we may see de- 
pressed vital status — hypochondria in men and 
hysteria in women. This condition is soon reversed 
by a good cleaning out of the bowels, followed by 
light diet and plenty of out door exercise. The 
sad depressed face lights up with a happy smile 
that rivals the joyous child at Christmas time." 



THE RECTUM. 

The Rectum is the lower extremity of the large 
bowel called the descending Colon. It is situated 
in the lower part of the abdominal cavity, behind 
the bladder and the womb, and in front and below 
the lower extremity of the backbone. 

It is from four to six inches long and varies in 
its inside diameter from ij(to 2 inches ; it may 
be dilated to a much greater size, or contracted 
by stricture to the fraction of an inch. Its lower 
portion (just inside its mouth the anus) is sur- 
rounded and closed by a band of muscles called 
the sphincters. This band is about an inch broad, 
with its upper and lower edges so much thicker 
than the intervening fibres, as to be called, respec- 
tively the internal and the external sphincters. 
These muscles are well supplied with nerves, are 
very sensitive and are to quite an extent, under 
the control of the will. 

The chief nerve supply of the walls of the 
rectum is from the sympathetic nervous system 
which is not under control of the will and in 
normal condition is not sensitive. 



20 

The walls of the rectum are soft and elastic and 
capable of holding a surprisingly large mass of 
excrementitious matter. 

There is a net-work of good sized veins sur- 
rounding the lower end of the rectum for an inch 
or two. It is a remarkable fact, that these veins 
are not provided with valves and consequently 
whenever the abdominal portal or liver circula- 
tion is sluggish or obstructed, as by an overloaded 
colon from constipation, a congested liver, an 
abdominal or ovarian tumor, or from pregnancy, 
there is a strong tendency to stagnation in its 
lowermost tributaries — the veins of the rectum. 
Hence they are often found in a state of swollen 
enlargement, with thickened walls and pouch-like 
dilations which develop into piles. 

When it is also remembered that the course of 
circulation of the portal system is upwards to the 
liver, we may understand that those persons 
whose occupations confine them within doors, 
and whose work is performed in a standing posi- 
tion or even in a constantly sitting position are 
likely to be victims of stagnated portal circulation. 

Iyiterary and professional men, Dentists, Type- 
setters, Tailors, Hairdressers, Street car drivers 
and conductors, are all liable to these distressing 
disorders. The disorders of stagnated portal cir- 



21 

culation seem to be peculiar to civilized humanity; 
there is no analogous disease in quadrupeds where 
the body is horizontal and not in the upright 
position. Monkeys in confinement often show a 
swollen anus and not infrequently are victims of 
piles, in some form. 

The disease is almost unknown among barba- 
rians and Indians. The active outdoor life seems 
to keep the circulation under rapid motion, and 
the pure air oxidizes the impurities of the blood. 



DISORDERS OF THE RECTUM: 

The disorders most common to the rectum,, are 
Co?istipation ) Piles, Fistula, Ulceration, Strictures, 
and prolapsus or falling downwards through the 
anus of folds of the mucous membrane of the 
rectum, and in extreme cases the coming down 
and turning out of the lower end of the large 
bowel, the colon. 

The general and most common causes of dis- 
orders of the rectum, arise from constipation, 
diarrhoea, too good living, especially the con- 
sumption of large quantities of meat, very coarse 
fare, indulgence in alcoholic drinks, excessive 
smoking, violent and prolonged exertion, seden- 
tary occupation, exposure to wet or cold, dis- 
charges from the bowels resulting from internal 
diseases, pressure by the uterus during pregnancy, 
uterine displacement, friction from clothing use of 
printedpaper when the ink rubs off by the slightest 
friction on the moist mucous membrane of the 
anus; neglect of bathing the anus, which requires 
as careful and more frequent washing than almost 
any other part of the body. Straining at stool, 



23 

however induced is most injurious. Severe 
coughing or sneezing will often induce undue 
straining. The ill effects of straining are more 
common among children, from weakness of the 
parts and the undeveloped bone structure which 
aids to support the lower bowel. 

The habit of placing young children over the 
"chamber," and urging them to strain to produce 
passage is a most pernicious custom and may 
result in permanent injury of the parts, or the 
establishment of such abnormal conditions as to 
stamp ill health upon a child for a long time, that 
in all other respects is in the enjoyment of a per- 
fectly healthful action of body and mind. 

Infant children should be allowed to perform 
their act of defecation in a recumbent position, and 
older children should never be allowed to sit on 
closet seats where the hole is so small as to have 
a tendency to drag apart the buttocks, and thus 
strain open the anus ; this is likely to produce a 
fissure or crack which may cause much suffering 
from inflamation. The sitting upon the closet 
seat for a moment longer than is necessary is 
injurious at any period of life, and most injurious 
to children. 

In Country Villages and on forms in the Sum- 
mer time it is not uncommon to see children make 



24 

a "play house " of the "privy," they frequently 
sit over the " holes," by reason of the suggestive 
purpose of the place. Young girls and even more 
mature women, have a custom of visiting the 
' ' out-house ' ' in pairs and there pursuing con- 
versation. It is also not uncommon for persons 
to carry reading matter with them. All this is 
most pernicious ; First, by prolonged sitting, 
straining of the anus and muscular walls of the 
rectum is produced, a tendency to " bear down " 
is created and thus the mucous membrane of the 
rectum is turned out, and likely to be strangu- 
lated, causing -piles. Second, the atmosphere of 
a common " well hole privy ' ' is poisonous, loaded 
with " Malaria" and therefore must be very in- 
jurious to the general health. 

The "Out-house privy" in winter time is a 
most prolific cause of rectal disorders. The sub- 
jection of uncovered portions of the body to the 
cold air produces a chill and as a consequence 
defecation is hurriedly forced an imperfectly 
performed. 

Defecation should always be performed in a 
comfortable place, where nature will not be im- 
peded, and where the desire may be most fully 
accomplished. 

That this may be secured, modern sanitary 



25 

science has perfected the Water, and Earth closets, 
which should be placed in a comfortable room 
within the house, and thus contribute to hygienic 
result. In Summer time the " earth closet" 
should be used in the " out house." By the use 
of the earth closet excrementitious matter is deo- 
dorized and disinfected, thus preventing disease. 

The strain of passing water through a strictuie 
in the urethra is often attended with serious in- 
fluence upon the rectum, and this disorder should 
not be allowed to exist when relief is at hand, as 
it is now in every civilized community. 

Dr. Sperry says "It is a curious and misleading 
fact that the discomfort arising from rectal 
diseases are often most marked in other parts of 
the body. The bladder, the womb, the kidneys, 
or the lungs often seem to be the seat of disease, 
whereas these organs are only sympathetically 
complaining for the rectum, which because of its 
lack of spinal sensory nerves and its abundance of 
sympathetic nerves, must remain quite dumb as 
to its own feelings and must speak through 
organs that have an abundance of spinal sensory 
nerves. It is a sad fact that most persons have a 
silly delicacy or modesty in calling attention to 
discomforts of the rectum, and yet these diseases 
are most common, and ignorance both on the part 



26 



of the patient, and many physicians has caused 
much suffering, which might have been avoided 
if the trouble had been given immediate atten- 
tion." 

Rough papers or other substance, when rubbed 
on the delicate membrane of the anus, may cause 
irritations which not unlikely will run into fis- 
sures, ulcers, or pruritus-itching of the anus. 

A proper and safe closet paper is now specially 
prepared and may be had at the Drug or Dry 
Goods stores. 

The Albany N. Y. Perforated Paper Company 
have given attention to this matter and prepare 
special closet papers, and an oiled paper which 
has proved very satisfactory to those suffering 
from disorders of the anus. 

For some reason that is not well explained, the 
disorders of the rectum seem to be a subject that 
must not be spoken about in the family or to ones 
friends. Quacks and patent medicine vendors 
advertise, write and talk trash about these 
diseases as though there was some great mystery 
attached to the subject, but among intelligent 
persons and those of refined society a silence 
exists that is often the cause of much suffering. 
No mystery is made of the diseases of the kid- 
neys. It is quite common to hear ladies and 



27 

gentlemen talking of a friend who they say "is 
suffering or dying or dead from " " Bright' s dis- 
ease," or that 4 'one is suffering with diabetes (a 
disease, the indications of which are most promi- 
nently observed in the urine). They even speak 
of friends * ' who have stone in the bladder," or 
"who have suffered from passing small stones," 
etc. We do not approve of this general conver- 
sation on the subject of diseases — it were better 
that it were not so common — but the point we 
wish to make is this, that there is so much ignor- 
ance and foolish modesty exhibited by persons 
generally — both old and young, with regard to 
disorders in the rectum, or at the anus, that quite 
frequently the sufferer hides his or her malady 
until it becomes so severe as to put concealment 
beyond the question and thus there is presented 
an aggravated disease which at first might have 
been cured easily, while in the state of a mild 
disability. 

Dr. Charles B. Kelsey of New York, the spe- 
cialist, in his book, writen for the members of his 
profession describes his mode of interview with 
his patients about as follows. 

' ' Generally to one unaccustomed to the exa- 
mination of patients suffering with disease of the 
lower bowel, the diagnosis is surrounded by many 



28 

purely imaginary difficulties ; the idea is well 
fixed in the minds of patients, who under the 
false idea that an examination and diagnosis 
necessarily mean a painful use of instruments, will 
defer treatment until the disease has made irre- 
parable progress. The surprise of such patients 
when a diagnosis is made by mere sight or at 
most by a painless finger examination, is only 
equalled by that of the young practitioner, when 
told that only in exceptional cases is it necessary 
to use any instrument - whatever. At the same 
time, " a successful diagnosis of these diseases 
consists in taking nothing for granted. Every 
affection of the lower four inches of the bowel can 
be both seen and felt, and a disease which can be 
felt and looked at is generally easy to understand. 
He who fails to properly and successfully treat 
rectal diseases, is the one who has failed to detect 
the nature of the disease by a neglect of the 
necessary and yet simple methods by which alone 
a diagnosis can be reached, he must use his 
eyes and his fingers, and not deceive himself 
or his patient by jumping at conclusions in the. 
dark," 

The persons who have tried to cure themselves 
or who have been the victims of some quack or 
advertised pile medicine are the ones who assume 



29 

to know all about themselves and naturally fall 
into the error of attempting to instruct the 
physician. 

The sooner this class of sufferers, put their con- 
ceit behind them and come down gracefully and 
submit to skilful treatment the better for their 
future comfort and happiness. 

Study, of disease of the rectum has been taken 
up by Physicians as a specialty. In every 
large city there are several skilful physicians who 
devote their whole practice to these diseases, and 
it is the custom for other physicians of general 
practice to refer their patients afflicted by these 
disorders to the specialist. The same is true of 
the large towns and villages. Physicians are 
adopting the systems of treatment which have 
proven to be perfectly successful, after much 
study and careful experiment, so that to day, at 
almost any civilized point in this country or 
Europe, patients may have the services of spe- 
cialists, and it is eminently proper and the duty 
of every sufferer from these diseases in applying 
for relief to their local physician to ask — ' ' Have 
you had special instruction or experience in treat- 
ing these troubles ? " If the answer is no, then 
ask to be referred to one who has, or seek in 



30 

another community for a specialist who has the 
endorsement of the medical profession. 

In this enlightened age there is no reason why 
we should suffer from our own ignorance or be 
made the victim of the ignorance of others. 




CONSTIPATION. 

Constipation is the packing of excrementitious 
matters of the body which are secreted by the 
bowels, and separated from food by digestion, in 
the descending colon and rectum. 

Indeed it is not an uncommon occurrence for 
this impaction to take place throughout the en- 
tire length of the colon back to its connection 
with the small bowels, and even into the small 
bowels themselves. 

All kind of disorders result from impaction of 
fecal matter, whether it be in the large bowel or 
in the rectum, such as headaches, blood poison- 
ing, depressed vital status and breaking down of 
normal health. 

Constipation is very common among women 
and is the most prolific cause of displacement of 
the uterus, followed by all the ills which this 
abnormal condition causes. The nervous and 
hysterical condition which is so often seen among 
young women and children may often be traced 
to constipation, caused by neglect to respond to 



32 

the daily call of nature to cast out the effete 
matters from the body. 

" It is an almost universal physiological law 
that a person in .health should have one daily 
evacuation from the bowels." " Usually at a 
certain hour of the twenty four which in a 
healthy person is fixed and invariable, there is 
felt a desire to relieve the bowels, caused by a 
physiological process carried on without the 
knowledge or will of the individual. Simply 
from the force of habit, which has existed for 
years, or from the effects of a routine mode of 
life. " If this call of nature is at once responded 
to, the normal action in the economy of life 
results in healthful reaction, but if it is neglected, 
a penalty follows. " A sensible person having 
regard for health and comfort will promptly re- 
gard the hint that nature is ready to do her part 
in unloading from the body its refuse, and will 
allow no light or even serious matter, and no 
false modesty to interfere with the regular, daily 
evacuation." 

' ■ Should this call of nature be resisted, and by 
an exercise of the will, the desire be turned aside, 
the mass of fecal matter will most likely, by a 
reverse muscular action be forced backwards into 
the colon, there to remain until nature again 



33 

gives the hint, which if still further resisted 
results in constipation, from which there is no 
relief, except medical or mechanical treatment." 

" It is a curious fact that in all walks of life, 
the physician finds remarkable cases of long 
delayed evacuation, varying from days, weeks 
and even months, but in all cases there results 
reaction which causes the most serious physical 
disorders and disease." The causes of constipa- 
tion are many. The first and simplest is the one 
already hinted at — ignorance, carelessness and 
wilful neglect of the call of nature. li Women 
suffer more than men because b}^ accidental sur- 
roundings they allow a false modesty to defeat 
the natural desire ; and because their habits of 
indoor life and lack of exercise lessens the natural 
muscular movement of the bowels which should 
force the fecal matter to the point of evacuation. 
Pregnancy while it exists is also a most prolific 
cause of constipation. The call of nature con- 
tinuously disregarded, from either neglect or 
from local cause, establishes a state of inactivity 
of the lower bowel and soon there is fixed upon 
the person a chronic condition of constipation, 
which requires a constant use of artificial means 
for relief " 

Habits of life are prolific causes of impaction, 



34 

such as brain work at the expense of physical 
exercise ; over-eating, long sitting in one posture, 
improper nutrition, or lack of nutrition — any- 
thing which lessens the physical powers — may 
fairly be put down as a cause of this condition ; 
for this reason old people and infants are more 
apt to suffer. 

The habitual use of laxative pills, and mi. 
neral waters, is injurious for the bowel action 
soon runs into sympathy with the habit and 
nature fails to act without the artificial aid." 

The use of astringent drugs, opium, tea, alco- 
holic liquors, etc. The loss of fluids from the 
body by disease, the lack of sufficient fluid taken 
with the daily food, and the use of too concen- 
trated food, containing too little refuse matter. 
Indigestion, both in the stomach and bowels is a 
frequent cause. 

' ( Diseases of the rectum whereby the act of 
evacuation is rendered painful is also a most com- 
mon cause — by avoiding the pain the greater 
disorder is invited and the person falls sick all 
over and thus defeats the natural effort of nature 
to keep up a healthful condition.' ' 

" Surgical practice has demonstrated that it is, 
frequently due to malformation in the rectum or 
adjacent parts. 



35 

"Constipation is not only a symptom of dis- 
ease, but it is a disease of itself attended by its 
own train of consequences. When long continued 
it leads to certain changes in the bowel and 
adjacent parts. It is thus the most frequent cause 
of piles, fissures, ulcerations and abcesses. Pro- 
lapse of the bowel (or falling down) is often 
caused by this condition and cases of actual rup- 
ture from straining to pass the fecal matter are 
not uncommon, with fatal result' ' 

" The natural result of turning the large bowel 
or colon into a reservoir for solid matter is to 
cause dilation and paralysis of its w 7 alls, In this 
way it may assume vast dimensions, pressing all 
moveable organs out of their natural position. 
The walls also may become so thin from over- 
distension as to rupture under the influence of a 
laxative medicine. Constipation is often caused 
by a stricture of the lower bowel, and the strain- 
ing effort to pass the fecal matter through this 
stricture creates inflammation and ulceration.' ' 
The mouth of the anus is often unnaturally small 
and thereby interferes with the easy passage of 
the fecal matter. The sphincter muscle which 
closes the mouth of the anus may be very rigid 
and refuse to properly release at the moment of 
effort and thus an imperfect or partial stool will 



36 

• 

result in holding back the feeal matter. At the 
lower end of the descending colon just before 
coming into the rectum, the large bowel takes on 
a bent shape, like the letter S (called the sigmoid 
flexure) — this shape has been adopted by the 
modern plumber as a trap for the prevention of 
backward movement of impure gases (malaria) — 
and there is no doubt but that this form of the 
bowel plays an important part in the economy of 
the body, by preventing to a proportionate degree 
the return from the rectum of fecal matter and 
gases into the intestinal track, but if the evacu- 
ation of the rectum be neglected, then this S 
shaped terminal fills up and forces backward 
the impurity and this complication results in 
disease. 

The rectum and S shaped terminal may be 
both overloaded, and when the person performs 
the act of defecation, they may do so in such a 
hurried manner, as only to accomplish the relief 
of the rectum, whereas if a quiet and patient re- 
laxation at the stool be assumed, with a positive 
concentration of the mind upon the act, the nerv- 
ous system will respond, and a full evacuation 
may be had both of the rectum and sigmoid 
flexure, for perfect, healthful defecation, should 
include this. 



37 

One of the disorders not uncommon to the lower 
bowel, is an unnatural constriction of the mouth 
of the sigmoid flexure into the rectum. This 
maybe caused by a malformation, or a stricture, 
caused by disease, or local influence, it is a most 
serious disorder for it prevents the free passage of 
fecal matter into the rectum, and thus causes con- 
stipation in the descending colon, where it is most 
objectionable and most likely to cause serious 
constitutional disturbance. Such constipation can 
only be relieved by laxative medicines, so long as 
the cause remains, but the cause may be removed 
successfully by surgical treatment, and that with- 
out serious suffering. 

The natural act of defecation is largely influ- 
enced by the character of food taken into the 
body. The following foods are aids to nature. 
Oatmeal, cracked wheat, the various preparations 
of white and yellow corn, ripe and stewed fruits 
of all kinds, vegetables which contain a large 
percentage of water. 

Milk, if readily digested and taken in moder- 
ate quantity, does not interfere with free action of 
the bowels, but if it is not at once digested, and 
is crowded into the bowels it becomes one of the 
most prolific causes of constipation. This is 
most common among infants and those persons 



38 

who suffer from weak digestion The cheese 
particles — (casein) — of the milk crowd up 
the bowels and form hard undegested masses 
which have not infrequently been the cause of 
death. 

Tea is an astringent and should never be used 
by any one who has the slightest tendency to 
constipation. 

Coffee is a safer drink and acts as a laxative 
with most persons, but if it has the least influence 
as an excitant of the nervous system, it should be 
avoided, by reason of the general disorder it 
creates in the whole body. 

Brandy acts as an astringent with 95 per cent, 
of all persons. Alcoholic liquors of all kinds are 
seriously detrimental to health, as a rule, and to 
those who have the least tendency to constipation 
they are most damaging and should never be 
used. The reason for this lies in the chemical 
fact that alcohol has a powerful affinity for water 
and when taken into the body withdraws water 
from the tissues and excrementitious matter, and 
acts as a general dryer up of the natural liquid 
secretions ; it is at war with all natural functional 
action of the organs of the body and makes the 
possibilities of constipation more certain. 

Foods, such as poultry, game, oysters and fish 



39 

are most excellent, and rarely ever have a bad 
influence on natural defecation. 

The heavier flesh foods, such as beef, mutton, 
pork, etc., all have a tendency to create solid 
fecal matter, and those who have the least tend- 
ency to constipation should avoid them ; they are 
not the most economic foods, and their absence 
can well be supplied by other foods which contain 
the same nutritive value in concentrated, and 
more digestable form. 

Graham, whole wheat flour, and Boston brown 
bread, with all kinds of farinaceous foods when 
taken in moderate quantity are aids to natural 
defecation. 

A prolific cause is railroad travel. The motion 
of the car increases the natural motion of the 
bowels and excretory matter is more rapidly 
pushed down to the rectum. The conveniences 
for excretory action are not very inviting on the 
ordinary or extraordinary cars of railways, and 
the desire for evacuation is too often repulsed, 
and thus the excretory matter becomes impacted 
with all the attendant discomforts. This extra 
car-motion given to the stomach and bowels aids 
digestion, and creates unnatural or stimulated 
appetite, at every eating- station the traveller is 
likely to fill up, and thus crowd upon his system 



4o 

an excessive amount of food, and in turn refuse 
matter is crowded upon the bowels, the result is 
often " car sickness " with headache, dullness of 
the whole body and mental depression. 

One cause which contributes to a constipated 
condition is not as fully appreciated, as it should 
be, and that is the custom of wearing tight clothes 
over the abnominal cavity, the liver and stomach 
are forced down over the transverse colon and its 
free muscular action of urging forward into the 
descending colon fecal matter is interfered with, 
and thus impaction of matter is made in the 
ascending and transverse colon. This will occur 
among women from tight corsets or dresses, or 
from hanging around the waists heavy skirts 
which should be supported from the shoulders. 
Among men from wearing the pantaloons and 
vest very tight around the waist. There is no 
portion of the human body in which it is so im- 
portant that free natural movement should be 
allowed as that over the region of the bowels, and 
transverse colon, for the reason that we have 
already stated. 

"Persons who are habitually constipated, will 
complain of certain unpleasant sensations, head- 
ache, fullness of body, pains in the hips, or limbs, 
and various undefinable influences w T hich upon 



4i 

examination do not come up to the dignity cf a 
constitutional change, or pronounced disease, and 
yet such persons cannot be said to be perfectly 
well and in the enjoyment of health and hap- 
piness. In this way mental depression may 
occur, men become hypochondriac and with 
women it takes the form of hysteria with all its 
sad and unfortunate results. The bodies of both 
are suffering from poison.' ' 

" One of the serious results of constipation may 
be found in the many womb troubles incident to 
women." 

" The womb lies almost in front of the rectum 
and is separated from it by only a thin partition 
or membrane. It is suspended in position by 
ligaments or cords, sufficiently strong to keep it 
in position when it is in a healthy state. The 
packing of fecal matter in the rectum causes con- 
gestion of its blood vessels and this congestion is 
sympathized in by the womb and it in turn be- 
comes congested and gorged with an unnatural 
quantity of blood, and the hard and loaded rectum 
presses forward on it ; this pressure and the in- 
creased quantity of blood causes the womb to 
strain its cords, and in time they lose their tensile 
strength, and that serious disease, et falling of the 
womb is the result." 



42 

Many persons are afflicted with constipation, 
by reason of a natural torpid condition of bowel 
action, the bowels fail to push forward promptly 
ih^ waste matter secreted into them, this condi- 
tion of weakness is liable to produce daily dis- 
tress, and symptoms of ill health. Constipation 
is often the result of habit contracted in child- 
hood, the desire comes on in the midst of 
play, it is resisted, and this often continued runs 
into habit, which stamps a fixed physiological 
condition upon the sufferer. 

Just here a serious mistake may be made, and 
a greater menace to health inaugurated, for if in 
the advertisement of patent medicine vendors the 
sufferer thinks he recognizes the symptoms of his 
disability, he is likely to undertake personal cur- 
ative measures, and thus establish a habit of 
depending on cathartic medication for his daily 
relief. 

Under this habit the bowels fall into still 
greater weakness and in time very serious com- 
plications are likely to arise. Whereas if a proper 
medical treatment is accepted, prompted by cer- 
tain indications which are recognized by the 
physician, this unfortunate condition, may be not 
only successfully relieved by palliative hygenic 
measures, but a normal condition may be reestab- 



43 

lished and natural habit of full daily evacuation 
accomplished. 

Persons who live in cities, with the attendant 
disabilities to daily physical exercise, such as the 
temptation to ride in street railway cars rather 
than to walk. The living in close badly ventilated 
rooms and eating of more food than is necessary 
for repair of tissue waste, are very likely to be 
sufferers from constipation. Unnatural craving 
for food is frequently mistaken for appetite, and 
when it is understood that this craving is more 
often a symptom of dyspepsia, caused by food 
lying in the stomach and bowels, under the in- 
fluence of weak digestion, it will be appreciated 
that the further forcing upon the body of more 
food is likely to bring on impaction in the bowels. 
This is frequently observed among children by 
over- feeding with milk. 

There may be other causes of constipation 
which are not at once developed and require the 
careful investigation of the skilled physician. 

Thus briefly have w T e referred to the most 
general causes of this most unpleasant and dan- 
gerous disorder; it will now interest us to examine 
the means of avoidance of the disease, and the 
cures which are possible. 
First of all, let it be firmly impressed upon the 



44 

mind that it is an absolute rule of nature that 
habitual daily evacuation of the bowels is a neces- 
sity, if we desire the enjoyment of health, and 
that all other conditions of daily life should be 
made subservient to this. 

Experience and close observation suggests that 
the best time to perform the act of evacuation is 
in the morning immediately following the first 
meal of the day, for the reason that during the 
night the bowels have been quietly at work forc- 
ing forward into the colon the refuse of food and 
the waste matters of the body which have been 
secreted into them. The moment that food is 
taken into the stomach and the act of digestion is 
begun the whole muscular formation of the 
stomach and bowels is thrown into active motion 
and thus the fecal matter is more forcibly pushed 
forward into the rectum and the desire for evacua- 
tion is most positive and should at once be res- 
ponded to. Thus the habit is formed, and the 
normal state of healthful defecation is performed. 

During the day, food and liquids are taken, and 
more or less exercise is had, there is of course 
stimulated activity given to the bowel motion, 
and as a consequence a large amount of refuse 
matter is carried forward to the lower bowel. 
Now if a second act of defecation is brought on, 



45 

say just before retiring it will be surprising to see 
what a large quantity of faeces will be passed. 
We have the testimony of a physician who made 
a careful study of this second act of defecation, 
with a number of persons, and it was his exper- 
ience with all his patients who made the practice 
of seeking two stools during the twenty four 
hours, that both were made with greater ease, 
that constipation and the many disabilities caused 
by it, was unknown to them. Having estab- 
lished the fact that a large amount of fecal matter 
is formed throughout the da}^ and does come 
down to the rectum, what an unnatural and un- 
healthful act it must be to carry it over night 
within the body, when by a simple effort at stool 
a large part of the corruption may be dispensed 
with, and thus the healthful normal state of the 
body reinforced. 

It is further important, that the habit of defeca- 
tion at night be adopted by those who have any 
disorder of the rectum, for if their stool be 
attended with any suffering, they can at once 
retire to a recumbent position, where relaxation 
and rest will soonest bring relief. At night on 
retiring, is the best time for the application of 
medicines or the use of the ice bag, sitz bath, or 
any other nursing which the disease may require. 



4 6 

Almost all of the lower animals exercise the 
act of defecation frequently during the twenty 
four hours ; disease of the bowels or rectum is 
practically unknow r n among them, why should 
not we with our greater (?) intelligence, seek to 
promote healthful bodies by an earnest regard for 
the laws of nature. 

There are many symptoms of abnormal pl^sical 
condition which present themselves in the morning 
at rising, headache, bad breath, bad taste in the 
mouth, a strong unpleasant body odor, soreness of 
the muscles and stiffness, all of these ailments can 
be, and most likely are the effects of overnight 
retention of fecal matter. 

The lower bowel is well supplied with blood 
vessels, and absorption through its mucous mem- 
brane into the bloqd circulation is quite as pos- 
sible as at any other part of the intestinal tract 
This is demonstrated by the system of supplying 
medicines and food to the body by rectal injec- 
tions. If we understand this susceptibility of the 
walls of the lower bowel to absorption, we shall 
be prepared to further understand what will be 
the result when refuse matter which should have 
been promptly evacuated has been retained in the 
colon and rectum. <c The gases and juices arising 
from the deca}^ed and fermenting mass will be 



'47 

absorbed, and entering into the blood circulation 
will proceed to poison the body. 

The impaction of fecal matter has a very serious 
influence upon the liver, causing imperfect secre- 
tion of bile, which is not infrequently retained in 
the bile ducts and is absorbed into the system, 
causing that most unpleasant and dangerous dis- 
ease called jaundice. 

The presence of impurities in the body from 
absorption, will produce fever, which in its 
symptoms takes on the type of typhoid, and 
indeed the patient will often go through all the 
various stages of this most dangerous disease. 
The congested, and feverish condition of the body 
renders it non-receptive to true nutrition, and" a 
low state of vitality carries the sufferer to the 
verge of a most distressing period of illness. If at 
this stage the cause is defined, and removed, a 
sense of returning vital force is recognised, and 
at once it is believed returning health is about to 
take possession, but at this point it is all im- 
portant that the continuation of treatment of the 
primal cause shall continue, for it takes not a few 
days, but weeks and at times months to remove 
the poison and its effects, from the whole system. 

Dr. William Henry Day of London, England, 
in his book on " Headaches" describes one form, 



4 8 

which has so much bearing upon the subject in 
hand that we quote the doctor's language in full. 

' ' In one form of headache the symptoms appear 
to have arisen from gas poisoning, i.e. gas gener- 
ated by putrefaction, fecal fermentation absorbed 
into the blood, aud thus producing its effects upon 
the brain and spinal cord." 

"This lorm of headache with gas poisoning, 
very much resembles the headache from gas pois- 
oning by sewer gas — from decomposed bodies in 
the dead house or dissecting room. The old "body 
snatchers " were quite familiar with it." 

This form of headache comes on usually in the 
morning and is very severe and vitally depress- 
ing. Could there be a better arguement in favor 
of defecation at night, as well as in the morning? 

Dr. Joseph W. Howe in his admirable little 
book "The Breath " says : " Constipation is fre- 
quently a cause of bad breath, disintegrated 
materials, which are thrown off through the 
mucous membrane, and the remains of undi- 
gested food, accumulate in the canal, (the in- 
• testines). 

The mass is passing rapidly through all the 
various stages of decomposition, and, by its pres- 
sure and irritation of the glands, it diminishes the 
normal excretory fuction, and nature, to maintain 



49 

an equilibrium, throws its surplus of excretory 
materials on the glands of other mucous mem- 
branes. Then again, the gases, in solution, arising 
from the decomposing accumulation, may be 
taken up by the blood-vessels and thus increase 
the effluvia." 

As shown by the ''feverish bad breath," the 
fetid odor of the impacted fecal matter in the large 
bowel has penetrated the blood vessels, and as the 
blood passes through the lungs the bad odor is 
breathed out and shows that the w T hole system 
is under the poisoning influence of a malaria (bad 
air) which has been generated within the body of 
the victim by their own carelessness or wilful 
ignorance. The first relief from this most dis- 
gusting condition is a good cleaning out, by 
cathartic medicines. But the result of wrong 
thus perpetrated against the body by contamina- 
ting its life-blood with a vile poison, will take 
days and possibly weeks to remove. Retained 
fecal matter produces sallow complection, swol- 
len and inflamed eyes, and eye lids and covers the 
face with pimples. There never was a truer say- 
ing — that, next to "godliness comes cleanliness " 
and w-e may well doubt, but that true godliness 
will come easier after true cleanliness. 

" The value of water taken into the body, by 



5° 

one who has been poisoned by constipation is 
large, it enters into the tissues and disolves the 
waste matters and aids in removing them to the 
excretory organs. The fecal matter of the bowels 
is softened and evacuation made easier ; the kid- 
neys are stimulated to enlarged secretion and the 
casting out of impurities ; the skin is made to 
perspire more freely and throw off impurity ; the 
lungs also throw off from the blood more moisture 
and with it more impurity. Water washes out the 
" house beautiful " and those who restrict the use 
of water, may be said to be " dirty inside." 

Waste of bodily tissue is constantly being 
thrown into the great sewer of the " house beau- 
tiful'' the intestinal tract, and is there forced 
forward to be thrown out, so that, natural health- 
ful reaction may go on, and the body be properly 
served w r ith fresh and pure nutriment. 

It is an ambition (worthy of the highest com- 
mendation) of all good housekeepers that the 
house shall be kept clean and free from the least 
approach towards accumulation of trash or useless 
material. Cities and towns spend vast sums in 
perfecting their system of sewerage, and removal 
of street dirt — public sentiment sustains this — 
and what a howl goes up if streets are neglected, 
or when any offensive or dirty business is set up 



5* 

within reach of the nose or eye — individuals, 
communities and newspapers at once join in the 
cry, and push forward the movement for clean- 
liness and health. What is all this clamor for? — 
that the dead and decayed animal and vegetable 
matter may be removed, and prevented from con- 
taminating the air we breathe, the water we drink 
or the food we eat, It seems strange that intel- 
ligent people, should exercise themselves in 
regard to their external conditions, and }^et seem- 
ingly be ignorant of the fact that an enormous 
quantity of foul and unclean matter is within 
their bodies, poisoning the foundation of their 
lives and sowing the seeds of disease and pre- 
mature death ! 

Constipation in the rectum unattended with 
any other complication, may be relieved by the 
use of water injected from a small bulb syringe 
carrying from four to six ounces of water, this 
serves to break up the fecal matter, and by lubri- 
cating the mucous surfaces the matter passes 
more easily. It is not always necessary to force 
the injections further up the bowel; when the 
rectum has thus been relieved, nature will take 
hold again, and the retained fecal matter above, 
will most likely be forced down. 

It is an established fact that the frequent 



52 

use of injections of water or other liquids to 
"bring on movement of the bowels is injurious 
and likely to establish a habit upon which the 
bowel and rectum by reflex nervous action learn 
to depend for aid and will not act without it. 
Yet there is at many times, urgent demand made 
for relief which cannot wait on a cathartic med- 
icine, in such cases the use of water injections are 
admissible. Frequently a sudden attack of piles 
comes on or there may be a fissure in the mus- 
cular tissue of the anus, or some other excitement 
or congestion, which would be greatly encouraged 
or made worse by a straining stool, at such times 
the use of water injections may be permitted, but 
care should be taken not to do more than break 
up the fecal matter so that an easy and painless 
passage may be had. Th? forcing of water beyond 
the rectum into the bowel may be attended with 
harmful results, and should not be attempted by 
any one without first having the advice of the 
physician. There are many different mechanical 
constructions of rectal syringes but the best 
for the safe use of the layman, without pro- 
fessional advice, is the small india rubber bulb 
syringe to which we have refered ; with this syr- 
inge it may take several injections at one sitting 
to produce the desired relief, still this is better 



53 

than throwing up a pint or quart of water at a 
time, for the extra pressure on the walls of the 
rectum may prove very objectionable, when it is 
alreacry enlarged by detained fecal matter. This 
small syringe has proven very serviceable as a 
means of washing out the rectum after natural 
passage, bringing away any small lumps of fecal 
matter that may be retained, or in cases of 
catarrh, washing from the mucous membrane 
impure secretions. 

There are cases of inflamation of the lower 
bowel w T hen the injection of water acts most 
kindly, it may be used hot or cold, and often 
allowed to be absorbed by the bowel. 

The use of strong soaps, either as suppositories, 
or in water solutions for injections, cannot help 
but be injurious to most persons. The alkali of 
the soap acts as an excitant upon the mucous 
membrane, or the sensitive surfaces of the anus 
and this more often produces ill results than good. 
If it is desired that an alkali should be used in 
rectal injections the nutral alkali, powdered borax, 
should be selected for the reason that it is not 
exciting, it softens the water and produces good 
lubrication, and is very cleansing to the mucous 
surfaces, removing adhering impure secretions 



54 

whether fecal or catarrhal, and thus promoting 
good healthful reaction. 

A teaspoon full of Vaseline injected into the 
rectum with an ointment syringe acts with great 
satisfaction ; it serves to lubricate the surfaces. 

The introduction of the middle finger, well 
covered with Vaseline will often prove a great 
help in promoting defecation. Hard fecal matter 
ma}^ be entirely removed by patients from their 
own rectum by a careful and intelligent use of the 
finger, but never use an instrument, this is only 
safe in the hands of a skilled physician. 

A glass of water with a teaspoonful of common 
salt taken before breakfast causes active intestinal 
secretion ; it breaks up fecal matter and brings 
on easy stools. 

It may be here mentioned, that the use of 
animal or vegetable greases in the rectum, should 
be discouraged as they have a tendency to become 
impure, or may be so, when used, and thus 
become active agents in producing disease upon 
the delicate mucous membrane. The exception 
to this may be in the use of Xanoline (wool 
fat) which does not change readily, and has 
a most benign influence on the membrane, and 
softens muscular tissue. The petroleum fats are 
very acceptable as they are unalterable, and have 



55 

superior lubricant action, and for inflamed or 
congested surfaces there seems to be more than 
an ordinary value to these fats. There are various 
grades of petroleum fats, but the best are those 
which are nearest white, and have a firm con- 
sistency, and have been made by distillation and 
filtration, without the use of chemicals. 

The use of suppositories made of cocoa butter, 
or glycerine have proved very serviceable. They 
ma}- be used overnight, or sufficiently long before 
the stool to secure a perfect melting of the sup- 
positor and perfect lubrication. 

Retention of fecal matter is not unfrequently 
the result of weakness, a failure of muscular or 
nervous energy. The stomach and intestines are 
just as likely to break down from over work as 
any other part of the body, and when such con- 
dition developes, it is important that great care 
should be exercised in the character of food taken, 
which should be of a liquid kind, and not over 
much in quantity. Still further is it important 
that decided rest be given to bodjr and mind. If a 
bloated condition of the bowels is apparent, im- 
mediate relief should be sought, by the use of mild 
moving medicines, accompanied by " Massage' ' 
and warm baths, and no further food should be 



56 

taken until a full relief is had by the passage of 
the retained fecal matter. 

A well tried and acceptable aid to bowel action, 
is that of "Massage" or kneading of the whole 
abdominal contents. This is accomplished by the 
patient or an assistant rubbing firmly and slowly 
the surface of the body over the stomach, liver 
and bowels. This treatment makes a better cir- 
culation of blood, it stimulates the stomach to 
eject food particles that may be lying dormant; 
the liver to activity, and the gaul bladder to 
secrete bile into the bowels. It stimulates the 
muscular action of the bowels to force forward 
their contents, and thus natural action is brought 
on throughout the entire system. 

The practice of " Massage " at the present day 
is aceepted as an important adjunct in producing 
healthful reaction of the body. It cannot be too 
highly recommended, particularly to those of 
inactive physical life ; it becomes to them an 
artificial exercise and produces proportionately 
good results, which always come from motion of 
muscular tissue. 

Motion of the body is as important in pro- 
moting healthful life, as food, air and water in its 
preservation. " Massage " is now dignified almost 
as a profession, and operators in this department 



57 

of ' ' Hygiene ' ' are trained after a system which 
has incorporated a knowledge of " preventive 
medicine.' ' 

Massage as an aid to bowel action can best be 
performed at night or in the morning while in 
bed, by lying on the back and systematically 
rubbing the abdominal cavity in the direction of 
a circle, beginning at the lower right hand side, 
rubbing upward along the ascending colon, then 
across the body over the transverse colon and 
then down the left side over the descending 
colon. "Massage" over the bowels should not 
be practiced if there is soreness, a tender feeling, 
or pain is caused, there may be obstruction, by 
twisting or doubling on themselves of a portion 
of the intestines, which will require immediate 
surgical care. " Massage" should never be rough, 
a firm gentle motion is quite sufficient. Infants 
and children often suffer from ' ' wind colic ' ' 
which may be relieved by this system. 

A most excellent relief from constipation is the 
present system of what is known as " Parlor 
Gymnastics," which in one case consists of a 
system of pullies and weights. Let the patient 
stand up and bending forward and downward 
draw the weights up until the hands touch the 
floor, this brings a pressure on the abdomina 



58 

muscles ; the liver, stomach and intestines are 
kept under pressure and activity, and the result 
is most beneficial. The whole body is exercised, 
and in healthful exercise lies one of the secrets of 
physical comfort and freedom from disability. 

Position of the body during sleep aids the 
movement of intestinal contents. It has been 
suggested that on re tiling one should rest on the 
right side, it helps the unloading of the stomach, 
as its exit is on the right hand side. It also aids 
the right hand unloading of the small intestines 
into the large ascending colon. The latter half of 
the night may be passed on the left side as this 
helps the passage of matter through the trans- 
verse colon to the left side, where it descends 
through the descending colon to the rectum. 

This system seems reasonable, and the anato- 
mical location of the parts would indicate the 
practical result which should be expected. 

The act of defecation should be approached 
with earnest regard for nature and health. One 
has suggested that in this act, the whole body 
should be placed in the most positive relaxation, 
" let the head fall forward on the breast, relax 
the muscles of the back, hips, stomach and chest, 
thus the whole muscular system being softened 
the proper relaxation of the sphincter muscles will 



59 

follow and the act of defecation should be easy 
and full." 

We have referred to the unnatural rigidity of 
the muscles of the anus as one cause of retained 
fecal matter and constipation in the rectum. This 
cause may be readily removed at the hands of the 
surgeon by simply stretching the muscles, thus 
giving to the rectum a larger passage. This 
treatment may be accomplished in many cases 
without pain and no detention from daily occu- 
pation ; it may be done at one effort or it may 
take two or three. In some cases it may require 
instrumental or surgical interference but in any 
case, it is a most important and valuable treat- 
ment and may, by a few hours of discomfort avoid 
months or years of suffering, and ill health. 
We have endeavored to give the reader a plain and 
comprehensive idea of the disease — Constipation — 
and the various complications and diseases which 
are likely to arise from it. We have suggested 
several modes of relief, which it will be observed 
are really only palliative, and do not contemplate 
a perfect cure and removal of predisposing causes. 
When these causes arise from abnormal constitu- 
tional conditions, it were better for all persons to 
lock upon constipation as a symptom of disease 
and thus be prompted to seek early and reliable 



6o 

inedical treatment rather than rely upon the 
dangerous aids in the hands of ignorant, and even 
of some very intelligent laymen, such as cathartic 
pills, patent medicines of all kinds and syringe 
injections of water. Many diseases of the rectum 
and bowels and of the general health are brought 
on by the unadvised and indiscriminate use of 
these aids. They should never be used by an}^ 
one without first seeking advice from an intel- 
ligent physician. 

It therefore follows as a rule to be regarded by 
every one, who has falien a victim to constipation, 
that they should at once, without delay, seek the 
aid of professional advice, and see to it that the 
advice comes from those who are skilled, not only 
in these disorders, but whose general knowledge 
of diseases and their remote cause entitles them 
to high regard. 

The advice of laymen and quacks is most 
dangerous, for their ignorance of the special 
conditions to be looked for, may carry the sufferer 
into a more dangerous experience than that of 
constipation. 



HEMORRHOIDS OR PILES. 

The disease known as Piles is a most common 
disorder of the rectum, and with the exception of 
an ordinary ' ' cold " is perhaps, the most common 
of all human ailments. History records that 
Napoleon was a victim of hemorrhoids and that 
during the preliminary disposition of his army 
prior to the fatal battle of Waterloo, his usual 
energy was so much embarrased by the suffering 
from this malidy that it played no small part in 
the circumstances which led up to his defeat and 
finally to the revolution of the government of a 
powerful nation. 

INTERNA!, PILES. 

Internal Piles are swellings which occur on the 
face of the w T alls of the rectum ; the}^ vary in 
size, from that of a pea to that of a walnut, are 
often painful and almost always indicate inflam- 
mation ; under pressure from passage of fecal 
matter or from straining the pain is greater and 
frequently the surface of the tumor is ruptured, 



62 

and bleeding takes place, varying from a tea- 
spoonful to a much larger quantity. 

Internal or bleeding piles constitute a disease 
which is serious, inasmuch as it tends to under- 
mine the general health of the sufferer, to interfere 
materially with his usefulness, and even, in 
extreme cases, to place life in danger. 

It is insidous in its approaches and persistent 
in character. 

Internal piles form slowly, without much or any 
pain. They complicate themselves with more or 
less prolapse or turning down of the internal 
lining of the rectum, and are constantly liable 
to a loss of blood. It is this latter feature which 
renders the disease a serious danger to health and 
life, and urges the importance of seeking preven- 
tion and cure. 

There are rarely more than three or four of 
these piles formed at one time. As little rounded 
masses of enlarged veins they are projected for- 
ward on the surface of the rectum, and when they 
attain sufficient size they form more or less of an 
obstruction to the free passage of fecal matter. 
Daily forcible contact with fecal masses in process 
of being ejected from the rectum, gradually- 
subjects them to a- pressure and through the 
yielding of the rectal lining they are finally 



63 

pushed through the anus, carrying with them 
more or less of the mucous membrane, in which 
they have grown. The sphincter muscle con- 
tracting around their membranous attachment, 
prevents the immediate return of the pile and 
membranous mass, and it remains protruding at 
the anus — a cluster of livid, half-strangulated, 
tumors — from the surface of which, as the 
sufferer sits over the closet basin, the blood 
oozes and drops rapidly, and even flows in a 
stream. 

The presence of this protruding mass gives a 
sensation of something more to be expelled and 
this creates straining which increases the flow of 
blood and aggrivates the prolapse. After the stool 
and upon rising from the seat the mass will often 
return within the rectum, but there comes a time 
when this off-repeated demonstration causes a 
strangulation outside the anus, which will not of 
its own accord return. The grip of the muscle 
pinches, and a slight hurt is felt, then mechanical 
help is needed to return the pile ; it is not always 
successful and then comes inflammation, conges- 
tion and possibly ulceration, attended with great 
suffering and prostration, all of which might have 
been avoided by treatment at the inception of the 
tumor. 



6 4 

The causes of internal piles may not always be 
clear, but as the veins which become swollen are 
not supplied with valves and cannot control the 
supply of blood, and as these rectal veins are a part 
of the portal vein which ends in the liver, it may 
be readily understood that when the liver is torpid 
from any cause, and a sluggish circulation exists, 
this same condition is present in the rectal veins 
contributing to the possibility oi becoming en- 
gorged or swollen into piles. Neglect in evacuating 
the fecal matter from the bowel, is fatal to its nor- 
mal condition, and is sure to excite this disease. 

The loss of blood from internal piles, even 
before their presence is felt by protrusion is a 
source of much ill health, — Paleness, indigestion, 
languor and general prostration, are most often 
present, and form symptoms of the disease. 

The presence of piles is easy of detection by 
skillful examination, and it is well to require a 
searching investigation, and to freely consent if 
necessary, to it under the influence of an anaes- 
thetic. 

The radical cure of internal piles is well assured 
under the present practice of the surgeon-specialist 
and no one need hesitate in placing themselves 
under treatment and the sooner the better, for 
each day may prove a serious delay. 



65 



EXTERNAL PILES. 

External piles are generally located in the 
mucous membrane of the rectum near the mouth 
of the anus, and at stool they slip down and out. 
They may also be located so near the mouth of 
the anus, as to protrude at all times, hence the 
name " external.' ' These piles are very painful 
for the reason that the grip of the muscle around 
the anus pinches the tumor and causes great 
soreness and inflammation. 

Piles occur in the robust and weakly, in the 
rich and poor, in the active and sedentary. The 
skin around the anus and the mucous membrane 
at the verge of that aperture are remarkably 
delicate in structure ; they are also profusely 
supplied with nerves and small blood vessels so 
that anything tending to irritate this region will 
easily cause congestion and inflammation. They 
are most annoying and distressing and particu- 
larly so to those w 7 ho have to travel, for the closet 
will not always be such that special care can be 
taken ol the afflicted parts. 

The relief, or cure of piles is no easy matter, at 
the hands of the sufferer or layman. One would 
suppose from the advertized remedies found in 
every newspaper and on the fences, rocks and 



66 

buildings throughout the country that piles can 
be cured with the same ease that a pimple can 
be removed from the face. As a rule these nos- 
trums and remedies are frauds and in the main do 
a vast amount of harm. The theory — which is 
universal in these advertised cures — is this, that 
the swelling may be reduced by the application 
of astringents, but most of these astringents are 
so severe as to destroy the mucous membrane, 
exposing the more tender surface of the tumor ; 
a sore is created, which soon runs into ulceration 
and under the influence of ulceration, the tumor 
often bleeds and thus the pile is reduced, and the 
apparent relief is hailed as a cure, but it is not 
long befoie a new sensation is felt and upon 
examination there will be found a burrowing 
ulcerating sore, in other words a fistula. 

This serious result having been attained, the 
patient must go to the skilled physician for a 
cure. The Indian " Medicine man," when he 
found a sore, the nature of which was strange to 
him made a practice of burning it with a hot iron, 
thus he produced a sore with which he was 
familiar and then proceeded to cure it. 

The patent medicine man or " Quack " is not 
so wise as the Indian, for his pile ointment or 
ignorant treatment having created a sore he is at 



6 7 

sea as to its cure, and the sufferer is forced to go 
to the physician, to whom he should have gone in 
the first place and thus avoided suffering, and 
prolonged disease. 

The relief from a first attack of piles may often 
be successful, by the simple treatment of diet, the 
use of mild cathartic medicines, just sufficient to 
break up the fecal matter into a soft stool, and 
the free application of cold water, or still further 
the application of the ice bag. This treatment 
however has reference more especially to the 
external pile or such as come down at stool. 

The first attack of piles is likely to be neglected, 
or the patient may fall into the hands of the 
1 ' quack. " This is j ust the moment when a serious 
mistake may be made, and through ignorance, 
many weeks, months or years of ill health may be 
brought on. Give all such persons and their 
nostrums the go by, and seek out the best and 
most reputable physician and be governed by his 
advice, and do not delay this even for a day. 

There are special modes of treatment for the 
removal of piles, that are so skilful and intelligent 
and free from danger and suffering, that no one 
need fear to at once seek relief. This treatment 
is known to all intelligent physicians and if they 
do not practice it, they know members of their 



68 

profession who do, and to them they send their 
patients. 

The largest percentage of serious cases of piles 
comes from neglect of the first indication. The 
presence of a very small pile either internal or 
external causes an aggravation, which almost 
always leads on to greater development, it is a 
case of a 4< stitch in time saves nine." 

There are a few persons so constituted that they 
can give to their bodies the ill treatment of over- 
eating and drinking,* and other predisposing 
causes of piles and yet escape the disorder 
entirely. There are others who may have a 
slight attack and by very simple treatment recover 
at once, or the first indications may come, and 
disappear by operation of nature, but these are 
phenomenal cases, and should not be regarded by 
any one having a first attack for they are very 
likely to be the ones who do not belong to this 
phenomenal class, and consequently to avoid the 
disease, they should seek intelligent aid. 

Persons suffering from piles of either kind, are 
often deceived by the relief which comes from 
bleeding. At stool the mucous membrane cover- 
ing the internal or external pile, may break 
open and bleed by reason of the straining at pas- 
sage, or by reason of the rubbing of hard fecal 



6 9 

matter. The tumor will thus be reduced, and the 
swelling go down ; apparent relief has come but 
it is not real, for at the next stool the tumor will 
be found filled with blood and ready to give way 
and bleed. This is a dangerous experience to go 
through. In the first place the body is being 
robbed of its life — the blood — and in the second 
place, the tumor may run into a suppurating 
sore, and so on into an abcess or fistula. 

It does not follow as a matter of course, that 
when one has been cured of piles at the hands of 
even the most skilful physician, that they will 
not again be victims of the disorders. There are 
many persons who are predisposed to this ailment, 
either from inheritance, or by peculiar conditions 
of their constitution. Such persons must accept 
the situation, and appreciate " that eternal vigil- 
ance is the price of liberty." In the majority of 
cases skilfully treated, followed by ordinary care, 
the recurrence of piles are unknown. 

We have not described with great particularity 
the various details which attend the appearance 
of either internal or external piles, for the reason 
that the line of difference is not so fixed that the 
layman can distinguish the various kinds, only 
the eye or touch of the expert can note the differ- 
ence. Most of these formations may be relieved 



70 

by very simple and painless treatment, and the 
removal will be effectual ; while others require 
surgical interference and patient nursing ; this 
may also largely depend on the constitutional 
condition of the patient. We may, however, be 
reliably assured that modern skill in the treatment 
of these disorders has made great progress and 
that one who suffers may no longer dread the 
treatment however severe his case may be. 

"Before undertaking the treatment of a case of 
hemorroids, both patient and surgeon should come 
to a distinct understanding. The latter can 
assure the sufferer that he may be cured at once 
and for ever, if he desires, and this applies to all 
forms of the disease." The only cases in which 
this cannot be said, are those in which the patient 
is in such constitutionally pcor health that no 
interference is justifiable " 

Yet to persons of a low state of health, who 
could not stand a surgical treatment, great relief 
may be given by acceptable palliative measures, 
and following directions as to diet and daily 
living. 



7* 



PROLAPSUS, 

This is a descent of a portion of the mucous 
membrane of the rectum, through the anus. At 
times and in some aggravated cases greater 
portions of the rectum come down and even the 
lower end of the large bowel — the Colon — 
comes into view. There are still further com- 
plicated features of this disorder, but they would 
only confuse the mind of the lay reader, and we 
shall therefore not attempt to describe them. 

Prolapsus of the lower bowel is a most serious 
and distressing disorder and requires great skill 
and careful nursing to give the sufferer relief. 
This disorder may occur at any period of life ; 
it is not an unmanageable disability, when seen 
in time and earnestly regarded. There is no disease 
of the rectum which suffers so much from neglect 
as this. 

This turning out of folds of the rectum at stool 
is quite common and varies in mass, dependent 
on the ease or difficulty of the act of defecation — 
the extent of strain exerted. When this turning 



out does occur it should be the duty of the person 
to at once return the fold within the rectum. 
This may be done by a gentle pressure of the 
four fingers upon the mass, at the same time 
exert a gentle straining downwards, which re- 
laxes the sphincter muscles, then the greater 
pressure of the fingers slips the mass up into the 
rectum, where the constricted folds straighten 
out and should assume their normal condition. 

The replacing of the bowel w T ill be greatly 
aided by the use of the petroleum greases, for the 
surfaces being thus lubricated, slip by- each other 
with greater ease. 

The bowel should never be allowed to remain 
out for a moment after fecal matter has passed. 
The relaxed sphincter muscle reacts and exerts a 
grip upon whatever may be in the ring mouth of 
the anus ; if rectal mucous membrane is there, a 
strangulation is likely to take place of a vein, 
and thus a pile is formed. Prolapsus of the lower 
bowel is a disease common among children. 

In the adult it is not uncommon, but is 
generally the result of strain, 

In old men with enlarged prostate gland, the 
impression is given that there is something in the 
rectum to be ejected and strain is made with the 
result of turning out the bowel. Dysentery, 



73 

diarrhoea, seat worms and rectal polypus, con- 
stipation, stricture, and internal piles are all 
factors producing rectal strain and turning out of 
the bowel. 

When prolapsus of the lower bowel takes 
place, nature as a general rule seems to preserve 
a passage through the folds, but it is very small 
and often tortuous, this adds to the seriousness 
of the disorder, for it prevents the free passage of 
faeces, and produces retention. The prolapse may 
however take a more alarming condition, by 
becoming so twisted and distorted, as to close up 
the passageway and thus permanent obstruction 
is caused, w T hich will require heroic surgical 
treatment. The modern schools of surgery un- 
derstand this dangerous disease perfectly, and its 
successful relief and cure depends largely upon 
the amount of bowel involved in the prolapse. 
Therefore it is clearly the duty of the sufferer to 
come under surgical observation at the very 
earliest indication of the trouble. 



7\ 



POLYPUS AND TUMORS. 

Internal and external piles are denominated 
tumors and correctly so, but there are other 
growths which occur in the rectum, which are 
also called tumors, but they are of a more bening 
character and are known as a polypus, which is 
a tumor like formation growing upon the walls 
of the rectum, with a slender pedicle or stem, 
connection. 

In the simplest form polypus is a small pear- 
shaped tumor attached to the wall of the rectum, 
and not infrequently coming down and out at 
stool. They may assume considerable size, and 
often become ruptured by pressure of hard fecal 
matter, then they bleed — often very considerable 
in quantity and recurring at every stool, this 
bleeding is often quite exhausting by its per- 
sistence. These tumors occasion more or less 
straining, and there is tendency to increase in 
size and they not infrequently bring on prolapse, 
and may even become a source of irritable ulcer, 



75 

abscess or fistula, which may be cured by the 
removal of the polypus. 

The cause of this morbid formation is not 
well understood. That it is morbid, is certain, 
but that it is a malignant growth and cannot be 
cured is not true, for perfect eradication can be 
made by a simple surgical treatment, 

These morbid growths are more frequently 
found in young persons than in those of more 
advanced age. 

In adult life and in old age these many rooted 
(as their name indicates) tumors are more likely 
to take on a cancerous nature, and by persistence 
of their return, make the cure quite difficult 

In a child, the frequent desire for stool, and 
the strain to get rid of something, and the dis- 
charge of blood and mucous that follows, may 
often be mistaken for dysentery, whereas a 
careful investigation will show the presence of a 
pofypus tumor. 

These tumors as a rule do not cause pain, and 
thus may continue to grow to considerable size, 
before their presence is appreciated. 

The treatment of rectal polypus is as a rule 
eminently satisfactory. The usually slender 
attachment of the tumor to the wall of the 
rectum, makes its elimination an easy matter. 



7 6 

A pinch by the thumb and finger will often be 
all that is necessary. There is a tendency how- 
ever to severe bleeding and therefore their 
removal ough to be performed by skilful treat- 
ment, so that serious results may be avoided. 




77 



ULCERATION WITHIN THE RECTUM. 

* ' By this is meant a raw chronic sore any- 
where between the internal sphincter muscle and 
the S-shaped end of the descending colon. The 
ulceration may be so superficial as to be hardly 
perceptible, or it may be deep, even to perforation 
of the rectal walls. It may be limited to one 
point, or appear in many small patches. Usually 
the presence of the ulcer is not well defined, 
there may be slight pain or soreness, particularly 
at stool. 

The fecal matter may be marked with blood or 
pus, but the indication of the trouble may be 
much concealed, by circumstances. There are 
certain symptoms of physical disability caused 
by ulceration at any point of the body which are 
quickly recognized by the physician and if he 
cannot find evidence of the disease on the exterior 
of the body he will, if he be wise look for the 
trouble in the rectum, or seek for evidence of 
ulceration beyond this point. 

The treatment of ulceration of the rectum is 



78 

eminently a work for the skilled specialist. It is 
a troublesome disease and not easily managed 
and requires an exercise of great patience and 
loyalty to treatment. 

These ulcerations may come from catarrh, 
wounds, dysentery, scrofula, or syphillis. There 
may be tubercular ulcers which are more likely 
to occur in persons suffering from consumption. 

Inflaming foods or alcoholic liquors not infre- 
quently cause ulceration of the stomach and 
bowels, which extends to the rectum, and this 
ulceration is in the nature of a consumption, such 
as takes place in the lungs, and at times exhausts 
every skilful effort known to modern medical 
science in its treatment. 

Its symptoms are often mistaken for those of 
other diseases, such as diarrhoea, dysentery or 
attributed without scrutiny to "piles." 

It is only since the systematic exploration of 
the rectum under the influence of aneasthetics, 
that a perfect knowledge of this disease has been 
known. Ulcerations in the rectum and of the anus, 
b} reason of the anatomical construction of the 
parts, and the constant state of almost restless 
motion, which is a part of the nature of the 
muscles in this region, go far in establishing the 
continuous or chronic nature of the sores. The 



79 

highest authorities on this disease, pronounce it 
incurable if neglected. 

It is now well known that certain ulcers of the 
rectum tend to perforate its walls and give rise to 
abscess, and fistula, deep burrowing sores, which 
are likely to create blood poisoning, and always 
lower vital status and bring the sufferer within 
the pale of serious illness, whereby health is 
destroyed, and death made possible. 

Ulceration is always attended with thickening 
of mucous membrane, and loss of substance of 
surrounding tissue so that when they do heal 
they produce contraction of surface, which results 
in stricture of the rectum. Under proper treatment 
this serious result may be greatly avoided, and a 
normal (or nearly so) surface reproduced. 

The general causes of rectal ulcerations have 
been mentioned but it will serve a good purpose 
to examine specifically some of these causes. 

Local wounds are by far the most frequent 
cause, as when a slight laceration or perforation 
(probably trifling in extent), is prevented from 
healing by the irritating contact of faeces, by the 
expansion and contraction of the rectal space, 
and the strain which is put upon it by effort to 
eject constipated fecal matter. 

The bursting of a hsemorhoidal vein while 



8o 

straining at stool is a frequent injury which 
results in ulceration, abcess or the greater sore 
— a fistula. 

Internal piles by reason of the bruising of 
passing faeces may develo; ulcers on their apex 
and run into virulent sores. Pressure on the 
rectal walls at certain stages of pregnancy, and 
the strain attending confinement may and often 
does produce inflammation and ulceration in the 
rectum. 

The recovery from these wounds in a perfectly 
healthy person of good habits, is quite as certain, 
and quite as prompt in proportion to the sur- 
roundings as at any other part of the body, but 
they demand a more attentive and skilful treat- 
ment In one of a low state of health, who suffers 
from general physical disab: : 'ity, or under the 
influence of a disordered nervous system, or the 
victim of bad habits, wounds in the rectum are 
likely to present troublesome and dangerous 
sores, and defeat a medical treatment, which 
otherwise would be quite successful. 

Dysentery or severe diarrhoea have not infre- 
quently been named as the cause of bowel 
ulceration, it may be true that the morbid con- 
dition produced by these states of the system, is 
likely to be indicated b}^ bad-blood sores, but 



Si 

morbid and inflammed action of the bowels is 
much more likely to be produced by ulceration in 
them than from other causes, which will be likely 
to be mistaken for dysentery, or diarrhoea if a 
searching investigation is not made. 

Scrofula, syphilis, and other blood poisoning 
diseases are most prolific in the production of 
rectal ulceration. 

The radical cure of rectal ulceration does not 
admit of simple passive treatment. Temporary 
relief may he had, by modifying the diet so that 
the faecal residue, will be bland and unirritating. 
Milk, soups and cooked fruits are best, solid 
coarse food aggravates the disease, delays cure 
and consequently prolongs the suffering unne- 
cessarily. 

Rest in a recumbent position is very important 
as it relieves pressure on the rectum, and lessons 
the spasmodic activity of the muscular tissue. 

These ulcerations are not a disease that a lay- 
man or the sufferer can hope to treat with any 
permanent degree of cure . 

The "doctor druggist," the quack and c< ready- 
made medicine, man," have perpetrated more 
misery in this disease and caused more ill health, 
than they would care to answer for, at the bar of 
justice, or heaven. They must be avoided if sub- 



82 

stantial relief be desired ; for it is only by an 
intimate knowledge of symptoms and general 
physical conditions, together with searching sur- 
gical examination, that a reliable judgment can 
be made of the nature and extent of the disease, 
and the system of treatment to be adopted. 




83 



STRICTURE. 

Stricture or the unnatural lessening in size, at 
special places, in the rectum or bowel above it, or 
even at the anus, is a most complicated and 
annoying disorder, but it will respond to careful 
treatment, which necessarily must be surgical. 
Stricture produces the most unmanageable cases 
of retained faecal matter, which in its reactive 
influence on the body is most distressing. 

11 There are no maladies more baffling to the 
surgeon than ulcerations followed by strictures. 
In the earlier stages of ulceration and stricture 
from whatever cause (save cancer), treatment 
carefully selected, and persistently carried out, 
will do great good, and in favorable cases effect 
a cure, but the patient must have faith in his 
surgeon, and be prepared to submit to a long and 
careful nursing, even after a marked improvement 
occurs. 

Stricture of the rectum is not very common. 
It has been seen as a malformation in infants and 
even in adults, and is rarely the result of 



8 4 

abnormal or morbid growth, without the accom- 
panying cause of other diseases such as ulceration 
abscesses or fistula, or from wounds, either from 
within or without the body. 

The sufferer from stricture of the rectum should 
be a sufferer for the very shortest possible period, 
for he can be relieved and that with good 
assurance of permanent cure, but a loyalty born 
of patience and determination to get well must 
constantly reinforce the treatment. 

Fruits containing seeds must first have the 
seeds removed before they are eaten. Straw- 
berries are injurious to rectal diseases of an}' 
kind. Grapes, raisins and apple seeds are dan- 
gerous at all points throughout the intestinal 
tract, but especially so when any disorder exists. 

Whole or half kernels of corn, small bones, 
tough skins of grapes and raisins, or other fruits 
are dangerous, for the reason that they go through 
the intestinal tract without alteration, and are 
likely to be caught by the stricture, or even in 
the folds of the mucous membrane of the large 
bowel, and thus set up inflammation and ulcera- 
tion. There are quite a number of cases of 
intestinal ulceration, perforation and death, re- 
ported from the puncture of the sharp point of 
an apple seed. It pays to have intense regard 



85 

for the complicated, and delicate organization of 
our inner man. There are a great number of 
ignorant persons who pitch things into their 
stomachs and intestinal tract, as though it were a 
common sewer of such mechanical construction 
that any plumber could replace it, at the will of 
the owner. Such ignorance results in producing 
subjects for the hospital, and the care of the 
physician. 

Stricture of the lower bowel, pre-eminently 
demands a special diet. Concentrated and very 
nutritious foods are indicated. Milk, condensed 
milk, artificial foods of approved make ; cod liver 
oil, soups, gruels, and vegetables with the smallest 
percentage of woody fibrous matter. The object 
being to reduce the quantity of refuse matter as 
much as possible. 



86 



FISTULA. 

A fistula is a deep burrowing, narrow abscess, 
ulcer or sore. 

Fistula may be developed either on the verge 
of the anus, or internally in the rectum. It is a 
most serious disorder, andean never be the subject 
of treatment by laymen or by the sufferer ; it 
demands skilful treatment. In the hospital treat- 
ment of diseases of the rectum, fistula is the most 
frequent affection of the adult. It is more common 
among men than women, but it is often found 
among infants and children. It generally results 
from neglect, or improper treatment of piles, it 
may come from syphilitic sores, from a strain, or 
wound ; from whatever cause fistula does arise it 
is a dangerous disease, from which depressed vital 
status results, and not infrequently blood poison- 
ing. A suppurating sore on any part of the 
body is bad, but much worse when located at the 
anus, or in the rectum, where it is subjected to 
association with such impurity that it is likely to 
pass over the line between an ordinary sup- 



8 7 

paratiiig sore, to the condition of a virulent 
ulcer. 

Dr. Allingham states the following as some of 
the predisposing causes of fistula. " Injury to the 
anus, or the mucous membrane of the rectum by 
constipated motions, straining at stool, by the 
presence of foreign bodies, such as small bones, 
buttons, coins, seeds, etc., which have passed 
through the bowels to the rectum ; exposure to 
wet and cold, and particularly sitting on damp or 
cold seats after exercise when the parts are hot 
and perspiring.' ' 

Persons who have a constitutional tendency to 
scrofula, or who have a depraved or low state of 
the blood such as frequently gives rise to boils 
and carbuncles ; consumptives, and those who 
have diseases of the blood or tissues, from syphilis 
or other blood poisoning influences are often easy 
victims of fistula. 

In the majority of cases, this disease begins by 
the formation of an abscess, immediately beneath 
the skin just outside the anus; or it may begin by 
ulceration of the mucous membrane within the 
rectum, when it is more serious, by reason of its 
constant association with fecal matter. 

These abscesses may form quickly and go 
through all the stages of congestion, inflam- 



88 

mation, swelling, gathering of pus, bursting and 
discharge, and if under correct and watchful 
treatment, a cure will follow at once, and the 
experience will be like that attending a severe 
boil ; but there is another phase of this disease 
which is most deceptive, and insidious in its 
formation ; it may be months in coming to a full 
development, it may be painless and the only 
knowledge had of it, is the presence of an 
enlargement which can be felt at the side of the 
anus. 

This form of abscess is the most dangerous, as 
it is apt to be neglected, and a burrowing fistula 
up the outside of the inner wall of the rectum will 
be the result. 

Abscesses at the anus as a rule are not seen as 
soon as they should be by the physician. Patients 
may feel a slight swelling, a little soreness, 
burning or itching sensation, it seems to call for 
a treatment of hot fomenations, poultices, or a 
temptation to rub with astringent ointments, 
this is but temporizing with a disease which is 
beyond the management of palliative measures. 

There may be pus matter beneath the sur- 
face of the swollen spot, and it is safer to 
make an incision, even if it is not at once 
present, than to allow a day to pass with a mass 



of pus held up by the abscess. It is bad advice 
to accept when you know you have an abscess, 
that so long as it does not give you serious 
trouble, or pain, to let it alone. The longer these 
disorders are allowed to exist the more difficult it 
becomes to cure them. It is a mistaken idea that 
nature has a cure for every ill, and this is one, in 
which it is eminently proper that nature should 
be quickly and forcibly aided in her effort to 
throw off the disease. 

Abscess and fistula at the anus may be success- 
fully treated, without surgical operation, but it 
takes time. In hospital treatment the work is 
usually among the poorer classes ; time to them is 
capital, and here we find the surgical treatment 
accomplishing quick and satisfactory results. Let 
it be understood, that the sooner the patient comes 
under medical care the sooner will be his relief, 
from a dangerous menace to health, and personal 
comfort. 

The tendency of medicine and surgery is 
steadily toward more mild and simple methods of 
treatment, and great progress has been made, in 
the surgical treatment, and character of medicines 
used, and this treatment is now widely understood 
by the profession. 

The temptation to rest satisfied with relief from 



90 

palliative treatment, is often adopted by reason of 
occupation or peculiar surroundings. Such relief 
is only apparent and not real, and the sufferer is 
more likely carrying' about with him a poisoning 
sore, which is insidiously breaking down hit 
health and rapidly urging him into a state of 
decline. Medical treatment of this disease, must 
have the further aid of great care in dietary habit 
which must be such as may be indicated by the 
character of the disease. 



91 



FISSURE AND PAINFUL IRRITABLE 
ULCER OF THE ANUS. 

This is a painful and by no means uncommon 
affection it is more frequently found among 
women than men ; it may occur #t any stage of 
life. Fissure or cracking, may be brought about 
by an injury or tearing of the delicate mucous 
membrane just inside or at the verge of the anus ; 
or outside in the deep separation between the 
buttocks, it may be caused by the passage of hard 
fecal matter, or by straining, either at stool, or by 
some other muscular exertion ; sometimes it 
follows severe diarrhoea ; it is frequently seen 
after confinement, when the mucous membrane 
has been torn apart. 

The origin of many fissures and ulcerations at 
and about the mouth of the anus, is syphillis, in 
both sexes, and among women the purulent 
matter of lyuecorrhcea, passes to the anus and sets 
up an inflammation, which results in ulceration 
and fissure. 



9 2 

Persons suffering from fissure or irritating 
ulcers at the anus, imagine they are the victims 
of piles, the symptoms are often mistaken one for 
the other. Often physicians are satisfied with a 
patient's description, and treats the case as one of 
external piles. 

If a physician is satisfied to treat diseases of the 
anus or rectum, depending upon the statement of 
his patients or the description by a mother or 
nurse, wihout a close and searching examination, 
he should not be trusted with the case, and if his 
patient declines to allow the fullest examination, 
it should be his duty to refuse to treat the case 
upon any terms, that does not admit of eye and 
finger examination. 

The suffering from pain by reason of a fissure 
is most acute at the time of evacuation ; some- 
times it comes on at the moment, and yet it may 
not develop for some time after the motion. Many 
who thus suffer avoid as long as possible the act 
of defecation, but this only makes matters worse. 
It will not do to delay treatment of fissure or 
irritable ulceration. The act of defecation should 
be as easy as possible. This may be done by 
the use of petroleum fats or injection of water, 
or the use of mild cathartics, just sufficient 
to break up the fecal matter so that it may be 



93 

passed without effort, this often serves as a re- 
active and curative treatment. 

Bathing freely with hot or cold water as 
experience shows best, proves most acceptable. 

The rubbing w 7 ith a mild ointment such as 
cold cream, or petroleum fats, after careful 
bathing, will serve as an excellent treatment, 
until a searching investigation and medical 
advice can be had. 

The use of rough paper is most injurious. The 
regular closet paper soaked in water is best, or 
the oiled paper before referred to will be found of 
great service. 

Fissure although a very serious disorder may 
be cured if treated at once, but it is likely to wear 
out the patient's health and strength in a re- 
markable manner — the constant annoyance from 
paiu and irritation to the nervous system is more 
than most persons can bear. They often imagine 
the ill to be more severe than it really is. They 
imagine they have cancer, piles, and all sorts of 
complications, and yet it is hard to understand 
how they can so long neglect the cure, by not 
coming under treatment which will relieve. This 
is especially true of young women, who through 
a false delicacy often conceal these disorders. 

One of the deceptions in the action of a fissure 



94 

is that it will frequently, without special treat- 
ment, close up, and apparently that is the end of 
the trouble, but it will not be long before it breaks 
open again, and this time be more annoying than 
at first. This may take place frequently until the 
trouble becomes almost chronic. 

This may be avoided by a first, correct and 
radical treatment. 

Ulcerations are frequently found just inside the 
mouth of the anus, and at stool they are most 
painful. These small ulcers are bad enough in 
themselves, but neglected, they will most likely 
run into fissures, or fistulas, and thus aggravate 
the disease ; they often give rise to imaginary 
nervous conditions the influences of which are 
hard to remove even after the ulceration has been 
cured. 

It may seem strange that so simple a disorder 
should be so painful, and give so much trouble 
while under treatment, but the fact is, that the 
muscles of the anus are usually very strong ; they 
are thickly supplied with nerves and when any 
spasmodic action of the muscles takes place the 
grip is severe, and thus the pressure upon the 
ulcer is great and the pain following is hard to 
bear. 

To those who suffer from ulcerations, or fissure? 



95 

it is better to cultivate the habit of evacuation 
at bedtime, so that at once relief from the 
painful stool may be had by treatment and 
rest in a recumbent position. A most excellent 
ointment to use, to soften the mucous membrane 
and to relieve pain, is made with wool fat (Lano- 
line) and Opium or Belladonna; mix with half 
an ounce of wool fat, one quarter of an ounce of 
sweet oil (wool fat used alone is too stiff and 
waxy). This ointment of wool fat and sweet oil 
alone is a most excellent adjunct to the closet 
and may be used with good effect in all troubles 
of the anus or rectum ; but it should be used only 
at night so that the influence for good may go on 
quietly during sleep. 

It is not safe to trust to any simple home treat- 
ment for fissure, or ulceration of the anus. The 
cause may be remote and it is wise to look 
beyond the mere sore to its exciting influence. 



9 6 



ITCHING AT THE ANUS. 

This is at times a most painful and always an 
annoying disorder. It renders life almost unin- 
durable, and is frequently most persistent. 

Itching of the anus is largely a symptom of some 
other functional disorder the character of which 
is not well defined, and must be sought for with 
intelligence. It is no respector of persons, all 
classes of society are liable to this disease. 

Those who indulge in eating and drinking of 
rich food and exciting liquids are most likely to 
suffer. Yet the disease has frequently been seen 
among those of most correct habits of diet. 

There are many cases which no doubt arise 
from a purely nervous condition, but usually 
there is some good cause to be found for the 
irritation. 

An engorged liver — plethora of the portal 
venus system — piles internal or external — use 
of rough closet paper — washing with strong 
alkaloid soaps or absence of bathing after stool 
— inflammation of the mucous membrane of the 



97 

rectum just inside the sphincter muscle — pres- 
sure upon the blood vessels of the anus from any 
cause — rubbing of clothing or contact of the dye 
in colored underclothing, or the irritation of 
woollens — latent gout, intestinal irritation from 
bad digestion — vermin, seat worms, vegetable 
and animal parasites ; these are all causes to be 
looked for. 

Among women, uterine diseases and the dis- 
order known as " leucorrhcea " not infrequently 
cause itching. The impure secretion passes from 
the vagina to the skin about the anus and creates 
an irritation. 

Active secretion of the sweat glands located 
about the anus, is frequently a cause, particularly 
so if the parts be rubbed or the outer skin be 
excited by scratching ; the acid perspiration and 
irritating character of the secretions then become 
the active cause of the disorder. 

The use of ready made ointments containing 
sharp astringents, frequently cause, or aggravate 
the disease. 

This is the locality where chronic eczema is 
found with its moist exudation and ferocious 
attacks of itching when the parts get unusually 
warm. 

The eating of shell fish, crabs, lobsters, salmon 



9 8 

or large quantities of flesh foods, drinking alco- 
holic liquors of high potency, or the heavy malt 
liquors, or excessive smoking of tobacco, will 
often cause this disease. 

The passage of bile from an engorged liver, by 
reason of medication or natural reaction, will 
often irritate the rectum and anus, and create a 
burning and continued itching sensation. 

Very fat persons often suffer from local chaffing 
of the buttocks and persons of slight physical 
organization may have the disease from nervous 
excitation, or from bad nutrition. 

Many persons of most correct habit and free 
from any rectal disorder not infrequently have 
experienced a slight irritation at the anus, the 
cause will be found to be the retention within 
the folds of the sphincter or the anus as it closes 
up, of a small portion of fecal matter which being 
spasmodically gripped by the muscles sets up the 
excitement ; the relief will be immediate by a 
slight injection of warm borax water, which will 
cleanse the parts. 

The relief and cure of itching, will be sug- 
gested, by the removal of many of the causes 
which have been stated. 

The home treatment is very successful by the 
application of cold water, night and morning. 



99 

Very great relief, and almost always a cure 
may be found in the use of the " Bedet " or the 
"Needle" upward douch, as seen in the "Russian" 
bathing establishments. 

The projection of a sudden and forceable stream 
of cold water against the anus and its surrounding 
skin, has proved a cure of this severe itching 
where all other remedies had failed. 

This application of water can be arranged for 
at home by attachment to the water closet 
fixtures of the " Bedet" pipe. 

It may also be accomplished by a stream 
from a "fountain" syringe, or by the forcible 
projection of water against the parts from the 
small hand bulb syringe. 

Splasing of water with the hand from the basin 
against the parts will also be found of great 
service. 

The use of the small bulb syringe will be found 
most useful to those who are compelled to travel 
and cannot have the constant use of their home 
comforts. 

The value of the use of water for affections of 
the lower bowel, the anus and its external parts 
will be more fully appreciated by the following 
irom the pen of Dr J. W. White, of Philadelphia, 
in Medical News January 12, 1889. 



too 

1 ' I refer to a moderately forcible stream of 
water of varying temperature in the treatment of 
a number of affections of the rectum, anus and 
genito-urinary apparatus. The atonic and astrin- 
gent effect of such a stream of water upon any 
living tissue is, of course, a well understood fact, 
and has been employed in the arrest of hemor- 
rhage, ill the treatment of inflammation, and in 
various other conditions. 

The bidet, as I have now for a few years pre- 
scribed it, should be of the variety which can be 
attached to the water-closet seat habitually used 
by the patient. It should have a nozzle capable 
of throwing a stream of about the calibre of an 
ordinary lead pencil or a little less. The head of 
water should be sufficient to make it impinge 
upon the parts exposed to it with enough force to 
excite there a little sensation of smarting and 
tingling. That degree offeree will, for example, 
be sufficient for a patient to take an enema, or, 
if a female, to take a vaginal injection. The bidet 
pipe should be movable by means of a handle, so 
that the stream can be directed against any por- 
tion of the external genitals, the perineum, the 
anus, or the surrounding parts. It should also have 
connection with the hot and cold water supply 
of the house, so that the water may be used of 



101 

any temperature which the physician may pre- 
scribe, or which the sensations of the patient may 
make desirable. Stopcocks should regulate the 
force and size of the stream, and should be so 
placed as to be easily reached by the hand of the 
individual sitting upon the water-closet seat. 
Such an apparatus can be put in place by an 
experienced plumber, in an ordinary water-closet. 
" The cases in which it may be desirable to use 
this method of treatment may be those affecting 
the lower end of the bowel and its outlet ; the 
most important are hemorrhoids, internal and 
external, prolapsus of the anus, and slight cases 
of prolapsed rectum ; itching and eczema of 
the anus should also be included in this group 
of cases in w r hich it has now for some time 
been my habit to prescribe the systematic 
employment, twice daily, of the bidet, once 
immediately after the daily stool, and for the 
second time, by preference, just before going to 
bed. As a rule, in all but the mid-winter months, 
the ordinary temperature of river water is to be 
preferred, although I am largely governed by 
the feelings of the patient in this respect. An 
enema should be taken at each of these times, the 
lower poition of the rectum being thus thoroughly 
washed out at least twice daily, after which the 



102 

stream of water is allowed to play upon the 
affected region for a period of from five to fifteen 
minutes. The ordinary and useful effect of cool 
sponging or washing immediately after stool in 
cases ol hemorrhoids is by this means enormously 
increased ; internal hemorrhoids will, under this 
treatment, in many cases almost entirely disap- 
pear, unless they are exceedingly large and have 
been frequently inflamed or strangulated and 
badly neglected ; external hemorrhoids, even 
when fleshy, will shrivel and become scarcely 
noticeable. 

" I could detail a number of cases of this char- 
acter taken from my practice of the last two 
years. In some instances in which I had been 
habitually called in, at intervals of a few months, 
in the cases of old people, the result has been 
practically their disappearance from my list of 
patients ; and they speak in the warmest manner 
of the great comfort which they have derived 
from this simple method of treatment. 

1 c Perhaps nothing is more distressing among 
minor afflictions than the trouble described as 
pruritus ani (or itching anus) and variously 
attributed to liver disease, constipation, gastric 
troubles, latent gout, uterine disease, parasites, 
neuroses, and a number of other causes, varying 



T03 

from the eating of shell-fish, or excessive smok- 
ing, to alleged hereditary predisposition. There 
are very few practitioners of any experience who 
have not discovered how difficult it is, in any 
particular case of pruritus, to assign distinctly 
the annoying symptoms to any one of these 
causes. Often the whole list may be carefully 
gone through and eliminated, or the proper 
remedies may be applied successively, as dif- 
ferent theories are adopted, without the slightest 
benefit resulting. Ointments, lotions, ordinary 
cool bathing, will be tried in great variety, but 
without avail ; and such patients will often go 
from one physician to another, or will fall into 
the hands of quacks while seeking relief. My 
treatment of cases of pruritus has been eminently 
successful by the use of the bedet, or forcible 
projection of cold water against the parts. 

Dr. Agnew (Surgery, vol. i. p. 445) says : 
1 ' There is something peculiar in the action of a 
fine stream of water ; it produces a much more 
energetic contraction of muscular fibre than that 
caused by bathing or sponging." 

And he further says of pruritus, that among 
the local remedies frequent ablutions with cold 
water should be mentioned ; and of prolapsus of 
the anus and rectum, that "in all cases where 



164 

remedies have proved unavailling, or where 
patients have declined an operation, much good 
may be done by douching the parts with cold 
water and applying an oiled compress ;' ' and 
Allingham says of the same class of cases, that 
" the frequent and bountiful application of cold 
w r ater is to be most strongly recommended.' ' 

The suffering from this itching is more often 
worse at night after getting warm in bed, or from 
physical exercise ; at such times relief may be had 
at once by the water treatment and application 
of petroleum fat, which lubricates the surfaces 
and allays irritation. The wool fat (L,anoline) 
ointment, with a mild opiate often helps at such 
times, and allays nervous excitement, and enables 
the sufferer to obtain the necessary sleep, which 
proves a great relief. The temptation to use 
internally opiates to secure sleep should be suc- 
cessfully resisted for the narcotic will create a 
habit which in its results will be worse than the 
disease and most disastrous to health. 

It is safe to say that any irritation at the anus 
should have as one of the reliefs, easy stools, 
straining or pressure from passing hard fecal 
matter is always attended with more or less 
excitement of the nerves of the sphincter muscles 
and sympathetically any other disorder at or near 



io5 

these nerves will be effected and this is as cert- 
ainly true in cases of itching as in that of fissure 
or other disability peculiar to this region. 

The form of this disease, which is caused by 
the growth upon and in the skin of a parasitic 
plant, or it may be the presence of an animalcule, 
requires skilful examination with the microscope 
to detect the presence of the cause, and then 
medicines must be used of a peculiar nature to 
eradicate these abnormal growths, and reproduce 
a healthy skin. The thread worm so common 
among children may be the cause of the itching. 
Injections of borax or lime water will most fre- 
quently remove this trouble. 

The presence of these little worms which look 
like small pieces of white thread is not always 
easy to determine, careful and frequent examina- 
tions ma}' be required to fix this cause. A 
practical way is to retain the lime water injec- 
tions in a basin and when the cause is thus 
found, the cure can be pursued with intelligence, 
but not often with rapid success in the adult. It 
requires intelligent and systematic treatment and 
decided loyalty on the part of the patient, to the 
necessary diet, and medical treatment. 

The application of extract of " Witch Hazel," 
solutions of White Oak bark, black tea, slippery 



io6 

elm bark, bicarbonate of soda or borax have been 
found very useful. The solutions may be made 
either with cold or tepid water as experience may 
prove to be best. A soft linen cloth covered with 
petroleum fat and held in place over the diseased 
part will be found a great relief at night. This 
prevents the rubbing of the buttocks and gives 
nature a chance to react and throw off the irrita- 
tion. 

Very extensive advertisements will be found of 
ointments for what is denominated " itching 
piles," there is no such thing. Piles of either 
kind may create local excitement, about the 
anus, but they cannot be cured with these oint- 
ments. They must be treated after a system 
indicated by their peculiar nature and then 
irritation will most likely disappear, but these 
secret ointments are much more likely to pro- 
mote the pruritus than to remove it. 

The various modes of treatment suggested 
come properly under the head of ' ' palliative and 
hygienic" measures and are likely to be more 
successful at the hands of the layman, than in 
any other disease peculiar to this region. But ii 
the disease be persistent, then a more skillful care 
and medication is demanded, for the cause may 



107 

be deep seated and the pruritus may be only a 
symptom, of a greater disorder. 

Pruritus should never be considered a small 
matter, only worthy of a passing notice ; it has 
great possibilities of suffering and may sucessfully 
defeat healthful physical or mental usefulness. 
It may call for much self-denial and great 
exertion of mental control. 




io8 



NEURALGIA. 

Persons wlio are subject to neuralgia in other 
parts of the body are quite likely to be 
attacked with severe or dull pain in and about 
the rectum. Upon examination not the least 
cause will be found apparent for the suffering, 
and yet on pushing the inquiry further, into the 
constitutional condition, or habits, a well con- 
cealed cause may be found that will solve the 
problem. Such investigation as this is not pos- 
sible at the hands of the quack or the layman. 

One may not unlikely be making a medicine 
box out of their body, upon the hit or miss plan, 
and by thus creating a depressed vitality keep up 
the disease almost beyond human endurance. 

This nervous, and painful disease not uncommon 
in the rectum is most often dependent upon a 
feverish condition of the bowels which extends to 
their terminal. This may be caused by constipa- 
tion, ulceration, stricture, intestinal obstruction, 
malformation, or improper diet ; any one of these 
causes may easily be discovered by proper inves- 



109 

tigation. Cooling medicines, the sitz bath, water 
packs, the " bedet " or massage, may prove to be 
the treatment indicated. The condition of the 
mind plays an important part in this disease, 
where the cause is not prominent, and personal 
judgment must be exercised in the direction of 
cultivating a salutary condition of the whole 
system. 




no 



CATARRH OF THE RECTUM. 

Catarrh is a chronic inflammation of mucous 
membrane and is quite common in the lower 
bowel. It is likely to do more harm in this 
locality, than in the throat or nasal passage, 
by reason of the difficulty of discovery and 
trouble of getting at the locality w r ith such treat- 
ment as may be necessary, and further by reason 
of association with fecal matter. 

Purulent matter forms on the inflammed surfaces 
of the walls of the rectum and from time to time it 
is forced off and carried out by fecal matter. It is 
also absorbed into the blood circulation, to the 
detriment of general health. 

Acute rectal catarrh produces various symptoms 
of inflammation and it is likely to produce diar- 
rhoea, or dysentery, and there is often so much 
congestion as to cause protrusion at stool giving 
rise to a suspicion of piles or other rectal disease. 
This disease may be quickly and radically cured 
but great regard must be had for dietary rules of 
living. An entire abstinence from the use of food 
or drink that would in the least degree excite the 



Ill 

mucous membrane of the intestinal tract must be 
adopted, for chronic catarrh of the stomach, and 
other digestive organs is quite common among 
those who use excitants in food and drink. This 
disease is not always stationary and from neglect 
or continued practice of the exciting cause, 
spreads to the intestinal tract and so on to the 
rectum. That over-loaded condition of the liver 
and portal circulation of which we have spoken 
which predisposes to hemorrhoids, is also a fruit- 
ful cause of catarrh. Inflammation of mucous 
membrane is almost always attended with the 
secretion of impure matter upon its surface. It 
may then be well understood that if we have 
inflammation in the rectum from no matter what 
cause, we are most likely to have purulent secre- 
tions, in other words catarrh. The treatment of 
this disease would seem to be from the vast 
number of advertised remedies an open secret, 
which any chemist may unfold with drugs that 
are claimed to affect every sufferer successfully 
and become a sure cure. There never was a 
greater mistake (to put it mildly) than to rely 
upon these catarrh mixtures. 

The disease is not easy of management because 
it is so difficult to convince patients of the remote 
cause, habits of daily life, clothing, diet, smoking, 



it* 

drinking, sleep and proper ventilation all have a 
bearing upon this disease, and thus the environ- 
ment of each person must be studied and often 
entirely changed. Catarrh cure-makers do not 
set forth what these changes or modes of life 
should be. They present a grease to be rubbed 
on, or a squirt gun to shoot a spray, or a powder 
to be snuffed, but they all bear upon their face 
the expression of doubt by their generalities. 
Catarrh of the stomach, the intestines or the 
rectum is a disease, no to be played with, it is a 
serious matter, and can only be relieved and cured 
by intelligent medical treatment. 

Self-denial is a rule to be learned in this disease, 
and the dismissal from daily life of all habits 
which tend to its creation. Climatic influences 
have much to do with the development of catarrhal 
affection ; these influences must be met with 
a constant defence of ' ' preventive medicine." It 
may be through the influence of clothing, the 
diet, the sleeping room or some habit, or the 
daily application to the mucous membrane of 
some cleansing medicated water, which defeats 
the growth of the purulent matter and keeps the 
disease within control, and more often succeeds 
in entirely curing it by the establishment of 
healthful reaction, from the predisposing cause. 



"3 



CANCER, 

" There are few parts of the human body which 
may not be attacked by cancer, but some are 
more frequently affected than others, and the 
rectum is one of the favorite sites of this disease. 
Cancer is, in the vast majority of cases a fatal 
disease, and when the rectum is the part affected 
it usually runs its course in about two years." 
Often in a very much shorter period. Cancer is 
as a rule a disease of middle life, and of the 
rectum is equally common among men and 
women. What are the predisposing causes of 
cancer ? Modern science is not able yet to answer 
this question. One point however seems now to 
be well settled, and that is, that cancer is not 
hereditary. There are diseases which are directly 
transmitted from parent to child, which may 
develope into a disorder of the skin or malignant 
ulceration, or tumors, and these tumors may be of 
the cancerous type, or direct cancer may develop, 
but direct transmission of cancer is not admitted 
by the majority of the medical profession at this 
day. I^et it be understood however, that a person 



ii4 

who suffers from cancer or other tissue poisoned 
disease, may entail upon their offspring great 
misery for which they alone are responsible ; here 
is a case where regard may well be had to the 
command. 

" Do unto others as ye would have them do unto 
yov." 

In the modern treatment of cancer of the 
rectum, the surgeon is able to give great relief 
from time to time and to direct a system of 
nursing, which brings comparative relief, and 
restriction of growth, even, if it does not result 
in cure. Surgical operations have been made and 
are now being made which ensure long, and in 
some cases entire relief from this much dreaded 
scourge of humanity. 

The proofs that thorough surgical operations 
accomplish the most favorable results in the 
treatment of cancer of the rectum, may be found 
in the records of almost an}^ hospital, private or 
public, w T here this disease has been submitted for 
treatment. There is no proof anywhere in this 
world that cancer of the rectum or cancer on any 
other part of the body has been cured, or even 
decidedly relieved for any longtime by the adver- 
tising " Cancer doctor," or by any of the trash or 
secret remedies which are offered to sufferers by 



H5 

Quacks and vampires who claim to be able to 
remove this pitiless disease. That many persons 
have been sufferers from running sores and watery 
tumors, located at points on the body where the 
cancerous growths are usually found, and that 
these persons have been cured by the use of 
internal and external medicines is quite true, but 
these sores and tumors were not cancerous, and 
the person who performed the relief either did or 
did not know that such was the case. 

They proceed upon the basis of purifying the 
body with well known remedies, and the cure of 
the ulcerous sore by antiseptics and alteratives 
that are known, in every dispensatory and 
hospital in the country. 

Modern medical science has investigated every 
cure, medicine and system of treatment, that has 
been suggested at any place in the civilized world 
for the cure of cancer, and charitable capitalists 
have spent thousands of dollars in building 
hospitals and stimulating investigation of this 
disease, so that at the present day if a sufferer 
becomes the victim of quackery, they do so wil- 
fully, submitting to be experimented upon at the 
expense of their pocket and almost certainly at 
the sacrifice of their life, provided they are the 
victims of this disease, 



n6 

The correct treatment of cancer, always sug- 
gests, the more vitalizing influence of country air 
and a simple natural mode of life. Plain and well 
selected food, nutritious in quality, and easily 
digested is of the utmost importance. If any food 
disagrees or causes gases in the bowels it should 
be avoided. Mik and milk foods, farinaceous and 
artificial foods, beef essences, cod liver oil, soups, 
eggs and fish are acceptable. Seed fruits and 
vegetables containing much woody fibre must 
be avoided. 

The most perfect system of diet for those suf- 
fering from rectal disease, is the use of such foods 
as contain the largest percentage of nutrition as 
against the lowest percentage of waste, so that 
the quantity of fecal matter will be reduced to a 
minimum. It is hardly necessary to say that the 
use of alcoholic liquors by those suffering from 
cancer is not admissible, under any circum- 
stances. It is important in this disease that 
constipation be avoided, but the laxative must 
be mild. It is not safe to rely upon personal 
judgment in this matter. The physician can 
much better judge of the character and quantity 
of laxative medicine to be used and deference to 
his judgment will save much illness and suffer- 
ing. The use of tepid water softened with the 



ii7 

neutral alkali, borax, proves of great service in 
keeping the parts clean, and a proper disinfectant 
used in the water is very important. 




118 



PALLIATIVE TREATMENT. 

It is an almost universal rule with persons 
having any unnatural feeling at the anus or in 
the rectum, to conceal the fact, and attempt some 
personal treatment, for relief. This is a most 
unfortunate exhibition of false modesty ; this 
concealment of a possible serious disability may 
lead to the development of chronic disease or 
decided impairment of health. 

In this most unpleasant complication of dis- 
eases it will not do to rely for relief upon personal 
judgment, and it amounts to almost criminal 
carelessness for one layman to advise another or 
for a physician who has not had careful training 
and experiences in these diseases to undertake 
their cure, for the sufferer simply becomes the 
victim of experiment. 

It is true that there are many persons who 
have what may be termed, adaptability to 
disease, their minds are so constituted and their 
"nack" of successful nursing, is so well devel- 
oped naturally, that they do secure relief from 
disease when it comes, and not infrequently 



ii 9 

accomplish cures, but sucli persons are like 
' ' angles visits, few and far between," and they 
are certainly persons who are naturally inclined 
to worship at the altar of " Hygiea." 

That palliative treatment at the hands of the 
physician, of rectal diseases, has been eminently 
successful there cannot be a doubt, but it is 
certain that in all such cases, the favorable sur- 
rounding circumstances were many, and such as 
could be wished for in every case, viz : home 
comtort, freedom from use of alcoholic liquors, 
more than ordinarily good general health, intel- 
ligent regard for diet, eating mild, nutritious 
food and only in such quantity as to repair 
natural bodily waste. 

Of the palliative remedies known, approved, 
and used with success by the profession, the 
safest are, cold and hot water, the ice bag, hot 
fomentations, cold and hot sitz baths. Injection 
of water into the rectum, often proves to be a 
very successful treatment for local inflammation, 
and not infrequently has proved a perfect cure of 
the disease. 

The continued use of mild moving medicines 
for several days, or even weeks, whereby the 
fecal matter is broken up, just sufficient to make 
the passages easy, thus relieving the strain on 



120 

the mucous membrane and muscular tissue, has 
proved a most benign treatment, especially in cases 
of ulceration, fissure and internal inflammations. 

It is better however to allow your physician to 
select the kind of moving medicine to be used, 
and it may be necessary from time to time to 
change these medicines, and only one familiar 
with the symptoms of disease can safely do this. 
The palliative result in the use of cathartics, lies 
in the fact that, free bowel action by reflex 
influence, not only relieves the plethora of the 
large bowel, but also the liver and portal venous 
system, and thus in turn the swollen rectal veins 
are relieved and incipient piles avoided. The 
extracts of "Witch Hazel" and 4 'Horse Chestnut" 
diluted with water and used as injections, or in 
the form of an ointment, made with wool fat, 
have proved of great service. 

It must be understood that palliative treatment 
of rectal disorders only contemplates the milder 
forms of internal and external disorders. The 
serious diseases are very likely to become more 
serious, by indulgence in temporizing measures. 

Rest in a recumbent position is most important, 
it relieves from vertical pressure and reduces con- 
gestion and inflammation by release from strain, 
and nervous agitation. 



121 

The value of cold water injections is mainly 
due to the effect of cold, in causing contraction 
of the muscular formation in the walls of the 
rectum. Hence, when thrown into the bowel 
before stool, besides softening the fecal mass and 
facilitating its expulsion, they tend to shrink the 
hsemonhoidal tumors and to render the sur- 
rounding tissues firmer, and thus to diminish or 
prevent protrusion. To facilitate palliative treat- 
ment great comfort will be found by having the 
basin of the water closet so large that a good 
quantity of water may be used for bathing and 
splashing against the parts after stool. Great 
relief will be found from prolapsus, ulceration, 
fissure, cancer, and large protruding piles, by 
having the stool in a recumbent position and by 
use of the "bed pan." This palliative system 
relieves the bad influence of the naturally 
strained position into which the rectum and 
anus is thrown when sitting over the closet. 

The free use of sweet oil taken with the food 
has proved to be an excellent relief where there 
is inflamed surface of the large bowel and rectum. 
A tablespoonful taken three times a day will be 
found in many cases to produce healthful reac- 
tion, and to soften the fecal matter and ease the 
passage. Sweet oil may be made palatable, if it 



122 

cannot be taken raw, by mixing with the yolk of 
eggs in the form of a dressing for salads, and 
several other foods. Raw linseed oil, taken in 
doses of a desert spoonful three times a day has 
proven a relief in many cases of inflamed rectum, 
and even where piles have been very trouble- 
some. 

This use of oils can only be accepted upon the 
fact that they do have a benign influence upon 
inflamed flesh surfaces either internal or external, 
being taken in excess of digestion, they mingle 
with intestinal and large bowel refuse^ and act as 
lubricators, thus breaking up fecal matter and 
promoting easy passage. That these oils have 
any special medicinal office cannot be admitted, 
and therefore must not be relied upon for cure. 



"3 



HYGIENE OF THE LOWER BOWEL, 

Hygiene, is that department of medical science 
which- is now denominated " preventive med- 
icine." The question, how shall the health of 
this part of the body be preserved, and diseases 
avoided ? is a very important one, and is quite as 
seriously considered by the true physician, as the 
question, how shall these diseases be cured ? 

The successful practice of Hygiene by the in- 
dividual or by the physician among his patients, 
demands the most devoted loyalty to laws of 
correct living, and an education of no mean 
proportions as to the care necessary in exer- 
cising the eternal vigilance necessary to secure 
immunity from disease. Health is just as catching 
as disease, if by ordinary care the internal body 
and its external surroundings are made as sus- 
ceptible ; as it is, health outnumbers disease a 
thousand to one, and it will do so ten thousand 
to one if regard be had to the well accepted 
and true modes of health promotion. 

The diseases of the lower bowel are almost 
always the result of carelessness, neglect or ignor- 



ance ; this is clearly demonstrated in hospital and 
private practice. 

The individual who sits straining to get rid of 
the contents of his lower bowel should be aware 
of the damage he is doing to the parts which he 
is subjecting to violence and how surely he is 
courting prolapsus, or piles, if not abscess or 
fistula. In disregarding the calls of nature, few 
persons recognize the danger they incur of loss of 
expulsive power, to pass the fecal matter from the 
body by reason of the over-distention of the large 
bowel. The anatomical construction of the rectum 
is a delicate and complex piece of machinery by 
which nature provides for the perfect accomplish- 
ment of this most important function ; which 
cannot be regarded as ignoble since nature has 
made it a condition of life and health in all 
animated beings to daily unload the lower 
bowel. The regular performance of this func- 
tion, is then one of the primary conditions of 
well-being, and its derangement is recognized as 
one of the first evidences of a departure from 
perfect health. Regularity is one of Nature's 
favorite habits ; and this should be solicited 
with gentleness, and the danger of straining or 
violence should be inculcated even from earliest 
childhood. 



125 

" If the evacuation can not be accomplished by 
moderate effort, then the cause of this unnatural 
condition must be sought for and removed ; for no 
person is "naturally costive" as the popular 
belief and mode of expression would seem to 
imply. 

Reference has been made to the bad influence 
of alcoholic liquors. A good deal has been written, 
and spoken on this subject, in the public press 
and on the platform, so much indeed that the lay 
reader has almost tired of it, and has failed to 
take it to heart with the earnest regard that seems 
to be necessary. Much that is purely sentimental 
and exciting has been said about alcohol, and yet 
when we remove this influence and come down to 
the calm scientific facts, two well defined and 
undeniable truths stare us in the face and we 
cannot get away from them. 

First. All poisons have the peculiar quality of 
creating in the human body, an appetite for 
themselves ; this is not an appetite within the 
true meaning of the word, it may more properly 
be described as a craving. 

We have an appetite for nutritive food, to repair 
bodily tissue waste, and normally this ceases when 
hunger is satisfied. But by the use of poisons 
there seems to be aroused within the brain new 



126 

emotions ; unnatural longings, craving or morbid 
desire for more, take possession of, and dominate 
the faculties of the mind. This by modern science 
is called " narco-mania" or in other words 
mania for narcotics, or poisons. Alcohols are 
denominated, " intoxicants," that is they toxicate 
or poison. This is true of many medicines, only 
the poison influence is so concentrated, and dan- 
gerous, that the ordinary layman fears death at 
once, if he attempts unadvised, their use; he 
prefers to place the responsibility where it belongs 
in the hands of the skilled chemist, or physi- 
cian. 

By the use of alcohol the fairly intelligent 
layman knows that he is being toxicated, but he 
thinks it is only a little at a time, and so he takes 
his chances as to ill results. With many the final 
denoument is long delayed, with others it is quick 
and decisive, but in all it is cumulative, and the 
bad influences from alcoholic toxication will be found 
in the temperate or intemperate use of this poison. 
It may be safely laid down as a proven proposition, 
that alcohol is at war with health and comits its 
victims by the tens of thousands yearly. 

Second. That alcohol plays an important and 
disastrous influence in its relation to the lower 
bowel must now be admitted as proven. The liver 



127 

or portal circulation receives nutrients through- 
out the whole alimentary tract, and carries them 
to the liver for purification. Thus it will be seen 
that next to the stomach and bowels the liver is 
the most important organ to receive the force of 
alcoholic poison. 

" Going there more concentrated than to any- 
other organ, it can but be that it should seriously 
derange, irritate and inflame it and so set on foot 
a train of evils which must inevitably, sooner or 
later prove disastrous." 

The pronounced disease of the liver caused by 
alcohol is that of hardening, its interlobular 
spaces become smaller from thickening of the 
tissue, and as a consequence free and formal 
circulation is interfered with and thus retro- 
actively the portal blood veins of the rectum 
are rendered plethoric, and the possibility of 
hemorrhoidal enlargements is contributed to, 
and when to this is added the inflaming in- 
fluence of the alcohol to the blood vessels, the 
reader will appreciate the train of evil results 
which are likely to come. 

But this is not all, the toxic effect of alcohol 
upon the brain and its ramifications — the nervous 
S}^stem — extends to the nerves of the lower bowel 
and vital status is weakened, and normal activity 



128 

greatly interfered with and thus again we have 
a menace to health. 

Alcohol robs the tissues, and contents of the 
intestinal tract of moisture by reason of its 
powerful affinity for water, therefore excremen- 
titious matter is dried up and its passage to the 
rectum retarded, and constipation follows. 

Hygiene of the lower bowel demands that 
alcohol shall never be used as a beverage, and 
rarely as a medicine and then only under the 
advice of physicians who fully appreciate the 
danger of creating a morbid habit from its use. 




129 



INFLUENCE OF THE MIND. 

The condition of the mind plays an important 
part in any system of rectal treatment. The fol- 
lowing quoted paragraphs from Dr. F. Leonard 
Corning in N. Y. Medical Journal, May 1889, 
forcibly suggest currents of thought which must 
prove of invaluable service to us. 

"The reciprocal relations of mind and body 
constitue one of the most thoroughly apprehended 
principles of physiology. From the earliest dawn 
of thought, humanity became conscious of a 
mysterious — yet real influence over the pertur- 
bations of flesh and blood and soon recognized 
this as the influence of the mind. ,, 

This fact has been known in a measure from 
the earliest date of the World's history, and the 
mystery of it was and is still used by "talismen, 
jugglers, priests, oracles, old men, old women, 
vandals, frauds and quacks, as power over ignor- 
ance and supers tition." 

' 'A striking exemplification of the intellectual 
vandalism which periodically breaks out in soci- 



13° 

ety, even the most civilized is at present afforded 
by that curious conglomeration of superstiton and 
grotesque fallacy, known variously as " Christian 
Science, " "Miad Cure" and " Faith Cure." A 
horde of fanatics, ignorant of the most rudi- 
mentary principles of medical science has swept 
down upon civilized society, with a mode of 
treating disease as quixotic as it is dangerous to 
the weak-minded victims of this modern phase of 
humbug." 

■ ' There has never been a time in the history of 
medicine when the influence of the mind over 
functional disorder has not been recognized by 
the intelligent physician. The more skilful and 
scientific methods of modern treatment of disease 
continue to look upon the salutary co-operation 
of the mind as an invaluable adjunct to the 
accomplishment of cure," In the hands of the 
reputable physician at the present day, the 
patient not only has the benefit of learning and 
extensive experience, but also whatever there 
may be of "Mind Cure " as prompted by the best 
advice in the cultivation of that serene condition 
of mental pose that will assure an absence from 
nervous excitement and exaggerated imagination. 

Think health and it is likely to come in the 
form of a salutary condition of the body. Think 



*3* 

ill-health, and the noxious principal will take 
possession of mind and body and drive out hap- 
piness, which is akin to health. 



END. 
















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